|
WIRES KIRSCHNER 1.0MM
|
Facility
OP
|
$161.00
|
|
| Hospital Charge Code |
8046903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.47 |
| 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 |
$81.26
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| 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 |
$80.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.47
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.50
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
|
|
WIRES KIRSCHNER 1.0MM
|
Facility
IP
|
$161.00
|
|
| Hospital Charge Code |
8046903
|
|
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 1.0MM X 150MM
|
Facility
IP
|
$191.00
|
|
| Hospital Charge Code |
8047027
|
|
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 1.0MM X 150MM
|
Facility
OP
|
$191.00
|
|
| Hospital Charge Code |
8047027
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.46 |
| 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 |
$96.40
|
| Rate for Payer: Amerigroup Medicare |
$96.46
|
| 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 |
$95.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$95.46
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.50
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$96.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.25
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$112.69
|
|
|
WIRES KIRSCHNER 1.25MM
|
Facility
OP
|
$191.00
|
|
| Hospital Charge Code |
8046403
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.46 |
| 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 |
$96.40
|
| Rate for Payer: Amerigroup Medicare |
$96.46
|
| 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 |
$95.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$95.46
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.50
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$96.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.25
|
| 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 |
$80.47 |
| 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 |
$81.26
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| 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 |
$80.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.47
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.50
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| 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 |
$9.50 |
| 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 |
$9.59
|
| Rate for Payer: Amerigroup Medicare |
$9.60
|
| 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 |
$9.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.50
|
| Rate for Payer: Medical Associates Commercial |
$14.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.50
|
| Rate for Payer: Midlands Choice Commercial |
$13.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.25
|
| Rate for Payer: United Healthcare Commercial |
$17.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.21
|
|
|
WIRES KIRSCHNER 1.6MM
|
Facility
OP
|
$161.00
|
|
| Hospital Charge Code |
8046901
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.47 |
| 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 |
$81.26
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| 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 |
$80.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.47
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.50
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
|
|
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 20MM 150L
|
Facility
OP
|
$191.00
|
|
| Hospital Charge Code |
8046404
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.46 |
| 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 |
$96.40
|
| Rate for Payer: Amerigroup Medicare |
$96.46
|
| 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 |
$95.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$95.46
|
| Rate for Payer: Medical Associates Commercial |
$143.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.50
|
| Rate for Payer: Midlands Choice Commercial |
$133.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$96.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.25
|
| Rate for Payer: United Healthcare Commercial |
$171.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$112.69
|
|
|
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
|
|
|
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
|
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
|
$263.00
|
|
|
Service Code
|
CPT 97602 GP
|
| Hospital Charge Code |
5520785
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$131.45 |
| 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 |
$132.74
|
| Rate for Payer: Amerigroup Medicare |
$132.82
|
| 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 |
$131.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$131.45
|
| Rate for Payer: Medical Associates Commercial |
$197.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$131.50
|
| Rate for Payer: Midlands Choice Commercial |
$184.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$133.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$197.25
|
| Rate for Payer: United Healthcare Commercial |
$236.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$155.17
|
|
|
WOUND CARE NON-SELECTIVE
|
Facility
OP
|
$206.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
7438786
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.96 |
| Max. Negotiated Rate |
$598.11 |
| Rate for Payer: Midlands Choice Commercial |
$144.20
|
| 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 |
$103.97
|
| Rate for Payer: Amerigroup Medicare |
$104.03
|
| Rate for Payer: Cash Price |
$164.80
|
| 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 |
$103.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.96
|
| Rate for Payer: Medical Associates Commercial |
$154.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$154.50
|
| Rate for Payer: United Healthcare Commercial |
$185.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$121.54
|
| Rate for Payer: Wellmark IA HMO |
$543.74
|
| Rate for Payer: Wellmark IA PPO |
$598.11
|
|
|
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 Non-Selective Debride Charge
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
752341
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.48 |
| Max. Negotiated Rate |
$598.11 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO |
$543.74
|
| Rate for Payer: Wellmark IA PPO |
$598.11
|
|
|
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 |
$19.49 |
| 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 |
$19.68
|
| Rate for Payer: Amerigroup Medicare |
$19.70
|
| 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 |
$19.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.49
|
| Rate for Payer: Medical Associates Commercial |
$29.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.50
|
| Rate for Payer: Midlands Choice Commercial |
$27.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$29.25
|
| 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 |
$24.49 |
| 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 |
$24.73
|
| Rate for Payer: Amerigroup Medicare |
$24.74
|
| 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 |
$24.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.49
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$24.50
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.75
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.91
|
|
|
WOUND CLOSURE BY ADHESIVE
|
Professional
|
$137.00
|
|
|
Service Code
|
CPT G0168
|
| Hospital Charge Code |
7982743
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$95.90 |
| Rate for Payer: Aetna of IA Medicare |
$13.14
|
| Rate for Payer: Amerigroup Medicaid |
$13.59
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.40
|
| Rate for Payer: Medical Associates Commercial |
$24.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.14
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.71
|
| Rate for Payer: Wellmark IA HMO |
$28.00
|
| Rate for Payer: Wellmark IA PPO |
$33.00
|
|
