|
WIRES KIRSCHNER 1.25MM
|
Facility
|
OP
|
$191.00
|
|
| Hospital Charge Code |
8046403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.95 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of IA Commercial |
$171.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.90
|
| Rate for Payer: Aetna of IA Medicare |
$108.87
|
| Rate for Payer: Amerigroup Medicaid |
$110.17
|
| Rate for Payer: Amerigroup Medicare |
$86.81
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$143.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$85.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.10
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.95
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$110.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$98.84
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$112.69
|
|
|
WIRES KIRSCHNER 1.25MM
|
Facility
|
IP
|
$191.00
|
|
| Hospital Charge Code |
8046403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of IA Commercial |
$171.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.90
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$143.25
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
|
|
WIRES KIRSCHNER 1.25MM-1
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
8046902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
WIRES KIRSCHNER 1.25MM-1
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
8046902
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$92.86
|
| Rate for Payer: Amerigroup Medicare |
$73.17
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.96
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.45
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$93.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.32
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
|
|
WIRES KIRSCHNER 1.60MM X 150MM
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
8046972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13.30 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna of IA Commercial |
$17.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.10
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.25
|
| Rate for Payer: Medical Associates Commercial |
$14.25
|
| Rate for Payer: Midlands Choice Commercial |
$13.30
|
| Rate for Payer: United Healthcare Commercial |
$17.10
|
|
|
WIRES KIRSCHNER 1.60MM X 150MM
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
8046972
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8.55 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna of IA Commercial |
$17.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.10
|
| Rate for Payer: Aetna of IA Medicare |
$10.83
|
| Rate for Payer: Amerigroup Medicaid |
$10.96
|
| Rate for Payer: Amerigroup Medicare |
$8.64
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.85
|
| Rate for Payer: Medical Associates Commercial |
$14.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.55
|
| Rate for Payer: Midlands Choice Commercial |
$13.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.83
|
| Rate for Payer: United Healthcare Commercial |
$17.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.21
|
|
|
WIRES KIRSCHNER 1.6MM
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
8046901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
WIRES KIRSCHNER 1.6MM
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
8046901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$92.86
|
| Rate for Payer: Amerigroup Medicare |
$73.17
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.96
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.45
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$93.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.32
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
|
|
WIRES KIRSCHNER 20MM 150L
|
Facility
|
IP
|
$191.00
|
|
| Hospital Charge Code |
8046404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.70 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of IA Commercial |
$171.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.90
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$143.25
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
|
|
WIRES KIRSCHNER 20MM 150L
|
Facility
|
OP
|
$191.00
|
|
| Hospital Charge Code |
8046404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$85.95 |
| Max. Negotiated Rate |
$171.90 |
| Rate for Payer: Aetna of IA Commercial |
$171.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.90
|
| Rate for Payer: Aetna of IA Medicare |
$108.87
|
| Rate for Payer: Amerigroup Medicaid |
$110.17
|
| Rate for Payer: Amerigroup Medicare |
$86.81
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$143.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$85.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.10
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.95
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$110.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$98.84
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$112.69
|
|
|
WOUND CARE NON-SELECTIVE
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
5520785
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$118.35 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Aetna of IA Commercial |
$236.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$236.70
|
| Rate for Payer: Aetna of IA Medicare |
$149.91
|
| Rate for Payer: Amerigroup Medicaid |
$151.70
|
| Rate for Payer: Amerigroup Medicare |
$119.53
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$197.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$118.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$150.23
|
| Rate for Payer: Medical Associates Commercial |
$197.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$118.35
|
| Rate for Payer: Midlands Choice Commercial |
$184.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$152.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$136.10
|
| Rate for Payer: United Healthcare Commercial |
$236.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$155.17
|
|
|
WOUND CARE NON-SELECTIVE
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
5520785
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$184.10 |
| Max. Negotiated Rate |
$236.70 |
| Rate for Payer: Aetna of IA Commercial |
$236.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$236.70
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$197.25
|
| Rate for Payer: Medical Associates Commercial |
$197.25
|
| Rate for Payer: Midlands Choice Commercial |
$184.10
|
| Rate for Payer: United Healthcare Commercial |
$236.70
|
|
|
WOUND CARE NON-SELECTIVE
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
7438786
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.70 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna of IA Commercial |
$185.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$185.40
|
| Rate for Payer: Aetna of IA Medicare |
$117.42
|
| Rate for Payer: Amerigroup Medicaid |
$118.82
|
| Rate for Payer: Amerigroup Medicare |
$93.63
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$154.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$92.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$117.67
|
| Rate for Payer: Medical Associates Commercial |
$154.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$92.70
|
| Rate for Payer: Midlands Choice Commercial |
$144.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$119.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$106.61
|
| Rate for Payer: United Healthcare Commercial |
$185.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$121.54
|
|
|
WOUND CARE NON-SELECTIVE
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
7438786
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$144.20 |
| Max. Negotiated Rate |
$185.40 |
| Rate for Payer: Aetna of IA Commercial |
$185.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$185.40
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$154.50
|
| Rate for Payer: Medical Associates Commercial |
$154.50
|
| Rate for Payer: Midlands Choice Commercial |
$144.20
|
| Rate for Payer: United Healthcare Commercial |
$185.40
|
|
|
WOUND CARE NON-SELECTIVE
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
7438786
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$77.91 |
| Max. Negotiated Rate |
$154.50 |
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Medical Associates Commercial |
$154.50
|
| Rate for Payer: Midlands Choice Commercial |
$144.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$154.50
|
| Rate for Payer: United Healthcare Commercial |
$77.91
|
|
|
Wound Care Non-Selective Debride Charge
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
752341
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.25 |
| 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 |
$49.03
|
| Rate for Payer: Amerigroup Medicare |
$38.63
|
| 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 |
$38.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.55
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.25
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.99
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.15
|
|
|
Wound Care Non-Selective Debride Charge
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
752341
|
|
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
|
|
|
WOUND CARE SELECTIVE <20 SQ CM
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
6542806
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.55 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna of IA Commercial |
$35.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$35.10
|
| Rate for Payer: Aetna of IA Medicare |
$22.23
|
| Rate for Payer: Amerigroup Medicaid |
$22.50
|
| Rate for Payer: Amerigroup Medicare |
$17.73
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$29.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.28
|
| Rate for Payer: Medical Associates Commercial |
$29.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.55
|
| Rate for Payer: Midlands Choice Commercial |
$27.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.18
|
| Rate for Payer: United Healthcare Commercial |
$35.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.01
|
|
|
WOUND CARE SELECTIVE <20 SQ CM
|
Facility
|
IP
|
$39.00
|
|
|
Service Code
|
CPT 97597 GP
|
| Hospital Charge Code |
6542806
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.30 |
| Max. Negotiated Rate |
$35.10 |
| Rate for Payer: Aetna of IA Commercial |
$35.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$35.10
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$29.25
|
| Rate for Payer: Medical Associates Commercial |
$29.25
|
| Rate for Payer: Midlands Choice Commercial |
$27.30
|
| Rate for Payer: United Healthcare Commercial |
$35.10
|
|
|
WOUND CARE SELECTIVE EA ADDTL 20 SQ CM
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
5907163
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
|
|
WOUND CARE SELECTIVE EA ADDTL 20 SQ CM
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 97598 GP
|
| Hospital Charge Code |
5907163
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Aetna of IA Medicare |
$27.93
|
| Rate for Payer: Amerigroup Medicaid |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$22.27
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.05
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.36
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.91
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS G0168
|
| Hospital Charge Code |
7982743
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$158.69 |
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Medical Associates Commercial |
$102.75
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.75
|
| Rate for Payer: United Healthcare Commercial |
$158.69
|
|
|
WOUND(S) CARE NON-SELECTIVE
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
4866825
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of IA Commercial |
$273.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$273.60
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.00
|
| Rate for Payer: Medical Associates Commercial |
$228.00
|
| Rate for Payer: Midlands Choice Commercial |
$212.80
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
|
|
WOUND(S) CARE NON-SELECTIVE
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
4866825
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of IA Commercial |
$273.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$273.60
|
| Rate for Payer: Aetna of IA Medicare |
$173.28
|
| Rate for Payer: Amerigroup Medicaid |
$175.35
|
| Rate for Payer: Amerigroup Medicare |
$138.17
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$136.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$173.64
|
| Rate for Payer: Medical Associates Commercial |
$228.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$136.80
|
| Rate for Payer: Midlands Choice Commercial |
$212.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$176.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$157.32
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$179.36
|
|
|
XENFORM TISSUE REPAIR 8MMX12MM
|
Facility
|
OP
|
$2,530.00
|
|
| Hospital Charge Code |
8026509
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,138.50 |
| Max. Negotiated Rate |
$2,277.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,277.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,277.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,442.10
|
| Rate for Payer: Amerigroup Medicaid |
$1,459.30
|
| Rate for Payer: Amerigroup Medicare |
$1,149.88
|
| Rate for Payer: Cash Price |
$2,024.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,897.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,138.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,445.14
|
| Rate for Payer: Medical Associates Commercial |
$1,897.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,138.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,771.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,466.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,309.28
|
| Rate for Payer: United Healthcare Commercial |
$2,277.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,492.70
|
|
