|
APPLICATION LOWER LEG SPLINT
|
Professional
|
$197.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
7982785
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$45.28 |
| Max. Negotiated Rate |
$137.90 |
| Rate for Payer: Aetna of IA Medicare |
$45.28
|
| Rate for Payer: Amerigroup Medicaid |
$46.82
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.19
|
| Rate for Payer: Medical Associates Commercial |
$86.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.28
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$67.92
|
| Rate for Payer: Wellmark IA HMO |
$94.00
|
| Rate for Payer: Wellmark IA PPO |
$110.00
|
|
|
Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system
|
Facility
OP
|
$7,259.89
|
|
|
Service Code
|
CPT 20690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,599.90 |
| Max. Negotiated Rate |
$7,259.89 |
| Rate for Payer: Wellmark IA HMO |
$6,599.90
|
| Rate for Payer: Wellmark IA PPO |
$7,259.89
|
|
|
APPLICATION OF FINGER SPLINT
|
Professional
|
$112.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
7982788
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$78.40 |
| Rate for Payer: Aetna of IA Medicare |
$26.09
|
| Rate for Payer: Amerigroup Medicaid |
$26.98
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$31.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.61
|
| Rate for Payer: Medical Associates Commercial |
$49.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.09
|
| Rate for Payer: Midlands Choice Commercial |
$78.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.14
|
| Rate for Payer: Wellmark IA HMO |
$56.00
|
| Rate for Payer: Wellmark IA PPO |
$66.00
|
|
|
APPLICATION TOTAL CONTACT CAST
|
Facility
OP
|
$406.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
8013707
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.92 |
| Max. Negotiated Rate |
$445.35 |
| Rate for Payer: Aetna of IA Commercial |
$365.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$365.40
|
| Rate for Payer: Aetna of IA Medicare |
$231.42
|
| Rate for Payer: Amerigroup Medicaid |
$204.91
|
| Rate for Payer: Amerigroup Medicare |
$205.03
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$304.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$203.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.92
|
| Rate for Payer: Medical Associates Commercial |
$304.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$203.00
|
| Rate for Payer: Midlands Choice Commercial |
$284.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$206.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$304.50
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$239.54
|
| Rate for Payer: Wellmark IA HMO |
$404.86
|
| Rate for Payer: Wellmark IA PPO |
$445.35
|
|
|
APPLICATION TOTAL CONTACT CAST
|
Facility
IP
|
$406.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
8013707
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna of IA Commercial |
$365.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$365.40
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$304.50
|
| Rate for Payer: Medical Associates Commercial |
$304.50
|
| Rate for Payer: Midlands Choice Commercial |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
|
|
APPL SKIN SUB < 100 1ST 25 CM FEET/TOES
|
Facility
IP
|
$569.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
8013703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$398.30 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Aetna of IA Commercial |
$512.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$512.10
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$426.75
|
| Rate for Payer: Medical Associates Commercial |
$426.75
|
| Rate for Payer: Midlands Choice Commercial |
$398.30
|
| Rate for Payer: United Healthcare Commercial |
$512.10
|
|
|
APPL SKIN SUB < 100 1ST 25 CM FEET/TOES
|
Facility
OP
|
$569.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
8013703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$284.39 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$512.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$512.10
|
| Rate for Payer: Aetna of IA Medicare |
$324.33
|
| Rate for Payer: Amerigroup Medicaid |
$287.17
|
| Rate for Payer: Amerigroup Medicare |
$287.34
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$426.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$284.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$284.39
|
| Rate for Payer: Medical Associates Commercial |
$426.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$284.50
|
| Rate for Payer: Midlands Choice Commercial |
$398.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$288.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$426.75
|
| Rate for Payer: United Healthcare Commercial |
$512.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$335.71
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPL SKIN SUB < 100 1ST 25 CM LEG/ANKLE
|
Facility
IP
|
$711.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
7438782
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$497.70 |
| Max. Negotiated Rate |
$639.90 |
| Rate for Payer: Aetna of IA Commercial |
$639.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$639.90
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$533.25
|
| Rate for Payer: Medical Associates Commercial |
$533.25
|
| Rate for Payer: Midlands Choice Commercial |
$497.70
|
| Rate for Payer: United Healthcare Commercial |
$639.90
|
|
|
APPL SKIN SUB < 100 1ST 25 CM LEG/ANKLE
|
Facility
OP
|
$711.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
7438782
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$355.36 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$639.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$639.90
|
| Rate for Payer: Aetna of IA Medicare |
$405.27
|
| Rate for Payer: Amerigroup Medicaid |
$358.84
|
| Rate for Payer: Amerigroup Medicare |
$359.06
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$533.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$355.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$355.36
|
| Rate for Payer: Medical Associates Commercial |
$533.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$355.50
|
| Rate for Payer: Midlands Choice Commercial |
$497.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$360.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$533.25
|
| Rate for Payer: United Healthcare Commercial |
$639.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$419.49
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPL SKIN SUB 1ST 100 SQ CM FEET/TOES
|
Facility
IP
|
$824.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
8013705
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$576.80 |
| Max. Negotiated Rate |
$741.60 |
| Rate for Payer: Aetna of IA Commercial |
$741.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$741.60
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$618.00
|
| Rate for Payer: Medical Associates Commercial |
$618.00
|
| Rate for Payer: Midlands Choice Commercial |
$576.80
|
| Rate for Payer: United Healthcare Commercial |
$741.60
|
|
|
APPL SKIN SUB 1ST 100 SQ CM FEET/TOES
|
Facility
OP
|
$824.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
8013705
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$411.84 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$741.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$741.60
|
| Rate for Payer: Aetna of IA Medicare |
$469.68
|
| Rate for Payer: Amerigroup Medicaid |
$415.87
|
| Rate for Payer: Amerigroup Medicare |
$416.12
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Cash Price |
$659.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$618.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$412.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$411.84
|
| Rate for Payer: Medical Associates Commercial |
$618.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$412.00
|
| Rate for Payer: Midlands Choice Commercial |
$576.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$418.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$618.00
|
| Rate for Payer: United Healthcare Commercial |
$741.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$486.16
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPL SKIN SUB 1ST 100 SQ CM LEG/ANKLE
|
Facility
IP
|
$930.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
8013701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$651.00 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Aetna of IA Commercial |
$837.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$837.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$697.50
|
| Rate for Payer: Medical Associates Commercial |
$697.50
|
| Rate for Payer: Midlands Choice Commercial |
$651.00
|
| Rate for Payer: United Healthcare Commercial |
$837.00
|
|
|
APPL SKIN SUB 1ST 100 SQ CM LEG/ANKLE
|
Facility
OP
|
$930.00
|
|
|
Service Code
|
CPT 15273
|
| Hospital Charge Code |
8013701
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$464.81 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$837.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$837.00
|
| Rate for Payer: Aetna of IA Medicare |
$530.10
|
| Rate for Payer: Amerigroup Medicaid |
$469.37
|
| Rate for Payer: Amerigroup Medicare |
$469.65
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$697.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$465.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$464.81
|
| Rate for Payer: Medical Associates Commercial |
$697.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$465.00
|
| Rate for Payer: Midlands Choice Commercial |
$651.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$471.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$697.50
|
| Rate for Payer: United Healthcare Commercial |
$837.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$548.70
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPL SKIN SUB EA ADD 100 SQ CM FEET/TOES
|
Facility
IP
|
$507.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
8013706
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$456.30 |
| Rate for Payer: Aetna of IA Commercial |
$456.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$456.30
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$380.25
|
| Rate for Payer: Medical Associates Commercial |
$380.25
|
| Rate for Payer: Midlands Choice Commercial |
$354.90
|
| Rate for Payer: United Healthcare Commercial |
$456.30
|
|
|
APPL SKIN SUB EA ADD 100 SQ CM FEET/TOES
|
Facility
OP
|
$507.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
8013706
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$253.40 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$456.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$456.30
|
| Rate for Payer: Aetna of IA Medicare |
$288.99
|
| Rate for Payer: Amerigroup Medicaid |
$255.88
|
| Rate for Payer: Amerigroup Medicare |
$256.04
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$380.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$253.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$253.40
|
| Rate for Payer: Medical Associates Commercial |
$380.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$253.50
|
| Rate for Payer: Midlands Choice Commercial |
$354.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$257.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$380.25
|
| Rate for Payer: United Healthcare Commercial |
$456.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$299.13
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPL SKIN SUB EA ADD 100 SQ CM LEG/ANKLE
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
8013702
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$70.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.20
|
| Rate for Payer: Aetna of IA Medicare |
$44.46
|
| Rate for Payer: Amerigroup Medicaid |
$39.37
|
| Rate for Payer: Amerigroup Medicare |
$39.39
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$39.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.98
|
| Rate for Payer: Medical Associates Commercial |
$58.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$54.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.50
|
| Rate for Payer: United Healthcare Commercial |
$70.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$46.02
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPL SKIN SUB EA ADD 100 SQ CM LEG/ANKLE
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT 15274
|
| Hospital Charge Code |
8013702
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of IA Commercial |
$70.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.20
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.50
|
| Rate for Payer: Medical Associates Commercial |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$54.60
|
| Rate for Payer: United Healthcare Commercial |
$70.20
|
|
|
APPL SKIN SUB EA ADD 1ST 25 CM FEET/TOES
|
Facility
OP
|
$173.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
8013704
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.47 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$155.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$155.70
|
| Rate for Payer: Aetna of IA Medicare |
$98.61
|
| Rate for Payer: Amerigroup Medicaid |
$87.31
|
| Rate for Payer: Amerigroup Medicare |
$87.36
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$129.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$86.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.47
|
| Rate for Payer: Medical Associates Commercial |
$129.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$86.50
|
| Rate for Payer: Midlands Choice Commercial |
$121.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$87.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$129.75
|
| Rate for Payer: United Healthcare Commercial |
$155.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$102.07
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPL SKIN SUB EA ADD 1ST 25 CM FEET/TOES
|
Facility
IP
|
$173.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
8013704
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.10 |
| Max. Negotiated Rate |
$155.70 |
| Rate for Payer: Aetna of IA Commercial |
$155.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$155.70
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$129.75
|
| Rate for Payer: Medical Associates Commercial |
$129.75
|
| Rate for Payer: Midlands Choice Commercial |
$121.10
|
| Rate for Payer: United Healthcare Commercial |
$155.70
|
|
|
APPL SKIN SUB EA ADD 1ST 25 CM LEG/ANKLE
|
Facility
OP
|
$1,357.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
7440782
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$678.23 |
| Max. Negotiated Rate |
$2,985.11 |
| Rate for Payer: Aetna of IA Commercial |
$1,221.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,221.30
|
| Rate for Payer: Aetna of IA Medicare |
$773.49
|
| Rate for Payer: Amerigroup Medicaid |
$684.88
|
| Rate for Payer: Amerigroup Medicare |
$685.28
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,017.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$678.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$678.23
|
| Rate for Payer: Medical Associates Commercial |
$1,017.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$678.50
|
| Rate for Payer: Midlands Choice Commercial |
$949.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$688.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,017.75
|
| Rate for Payer: United Healthcare Commercial |
$1,221.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$800.63
|
| Rate for Payer: Wellmark IA HMO |
$2,713.74
|
| Rate for Payer: Wellmark IA PPO |
$2,985.11
|
|
|
APPL SKIN SUB EA ADD 1ST 25 CM LEG/ANKLE
|
Facility
IP
|
$1,357.00
|
|
|
Service Code
|
CPT 15272
|
| Hospital Charge Code |
7440782
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$949.90 |
| Max. Negotiated Rate |
$1,221.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,221.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,221.30
|
| Rate for Payer: Cash Price |
$1,085.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,017.75
|
| Rate for Payer: Medical Associates Commercial |
$1,017.75
|
| Rate for Payer: Midlands Choice Commercial |
$949.90
|
| Rate for Payer: United Healthcare Commercial |
$1,221.30
|
|
|
APPLY FOREARM SPLINT
|
Professional
|
$168.00
|
|
|
Service Code
|
CPT 29125
|
| Hospital Charge Code |
7982789
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$36.55 |
| Max. Negotiated Rate |
$117.60 |
| Rate for Payer: Aetna of IA Medicare |
$36.55
|
| Rate for Payer: Amerigroup Medicaid |
$37.79
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.28
|
| Rate for Payer: Medical Associates Commercial |
$69.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.55
|
| Rate for Payer: Midlands Choice Commercial |
$117.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.82
|
| Rate for Payer: Wellmark IA HMO |
$77.00
|
| Rate for Payer: Wellmark IA PPO |
$90.00
|
|
|
APPLY LONG ARM SPLINT
|
Professional
|
$221.00
|
|
|
Service Code
|
CPT 29105
|
| Hospital Charge Code |
7982790
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$37.26 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Aetna of IA Medicare |
$37.26
|
| Rate for Payer: Amerigroup Medicaid |
$38.53
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.01
|
| Rate for Payer: Medical Associates Commercial |
$70.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.26
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.89
|
| Rate for Payer: Wellmark IA HMO |
$80.00
|
| Rate for Payer: Wellmark IA PPO |
$94.00
|
|
|
APPLY LONG LEG CAST BRACE
|
Professional
|
$535.00
|
|
|
Service Code
|
CPT 29358
|
| Hospital Charge Code |
7982864
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$92.57 |
| Max. Negotiated Rate |
$374.50 |
| Rate for Payer: Aetna of IA Medicare |
$92.57
|
| Rate for Payer: Amerigroup Medicaid |
$95.72
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Cash Price |
$428.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.42
|
| Rate for Payer: Medical Associates Commercial |
$175.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$92.57
|
| Rate for Payer: Midlands Choice Commercial |
$374.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$138.86
|
| Rate for Payer: Wellmark IA HMO |
$196.00
|
| Rate for Payer: Wellmark IA PPO |
$230.00
|
|
|
APPLY SHORT LEG CAST
|
Professional
|
$184.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
7982787
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$130.00 |
| Rate for Payer: Aetna of IA Medicare |
$53.25
|
| Rate for Payer: Amerigroup Medicaid |
$55.06
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.32
|
| Rate for Payer: Medical Associates Commercial |
$101.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$128.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$79.88
|
| Rate for Payer: Wellmark IA HMO |
$111.00
|
| Rate for Payer: Wellmark IA PPO |
$130.00
|
|
