|
TREAT FINGER DISLOCATION
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
4863411
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$436.80 |
| Max. Negotiated Rate |
$561.60 |
| Rate for Payer: Aetna of IA Commercial |
$561.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$561.60
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$468.00
|
| Rate for Payer: Medical Associates Commercial |
$468.00
|
| Rate for Payer: Midlands Choice Commercial |
$436.80
|
| Rate for Payer: United Healthcare Commercial |
$561.60
|
|
|
TREAT FINGER DISLOCATION
|
Professional
|
Both
|
$788.00
|
|
|
Service Code
|
CPT 26770
|
| Hospital Charge Code |
7982797
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$194.56 |
| Max. Negotiated Rate |
$671.90 |
| Rate for Payer: Amerigroup Medicaid |
$196.47
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Cash Price |
$630.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$194.56
|
| Rate for Payer: Medical Associates Commercial |
$591.00
|
| Rate for Payer: Midlands Choice Commercial |
$551.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$195.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$591.00
|
| Rate for Payer: United Healthcare Commercial |
$423.36
|
| Rate for Payer: Wellmark IA HMO WHPI |
$571.10
|
| Rate for Payer: Wellmark IA PPO |
$671.90
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$4,182.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
4863388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,927.40 |
| Max. Negotiated Rate |
$3,763.80 |
| Rate for Payer: Aetna of IA Commercial |
$3,763.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,763.80
|
| Rate for Payer: Cash Price |
$3,345.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,136.50
|
| Rate for Payer: Medical Associates Commercial |
$3,136.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,927.40
|
| Rate for Payer: United Healthcare Commercial |
$3,763.80
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
Both
|
$1,670.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
7982798
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$305.33 |
| Max. Negotiated Rate |
$1,252.50 |
| Rate for Payer: Amerigroup Medicaid |
$308.32
|
| Rate for Payer: Cash Price |
$1,336.00
|
| Rate for Payer: Cash Price |
$1,336.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$305.33
|
| Rate for Payer: Medical Associates Commercial |
$1,252.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,169.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$306.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,252.50
|
| Rate for Payer: United Healthcare Commercial |
$757.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$973.70
|
| Rate for Payer: Wellmark IA PPO |
$1,145.50
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
Both
|
$1,114.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
7982800
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$225.24 |
| Max. Negotiated Rate |
$835.50 |
| Rate for Payer: Amerigroup Medicaid |
$227.44
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Cash Price |
$891.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$225.24
|
| Rate for Payer: Medical Associates Commercial |
$835.50
|
| Rate for Payer: Midlands Choice Commercial |
$779.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$226.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$835.50
|
| Rate for Payer: United Healthcare Commercial |
$511.47
|
| Rate for Payer: Wellmark IA HMO WHPI |
$673.70
|
| Rate for Payer: Wellmark IA PPO |
$792.50
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
4863379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna of IA Commercial |
$673.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$673.20
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$561.00
|
| Rate for Payer: Medical Associates Commercial |
$561.00
|
| Rate for Payer: Midlands Choice Commercial |
$523.60
|
| Rate for Payer: United Healthcare Commercial |
$673.20
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
4863309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$673.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$673.20
|
| Rate for Payer: Aetna of IA Medicare |
$426.36
|
| Rate for Payer: Amerigroup Medicaid |
$431.45
|
| Rate for Payer: Amerigroup Medicare |
$339.97
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$561.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$336.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$427.26
|
| Rate for Payer: Medical Associates Commercial |
$561.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$336.60
|
| Rate for Payer: Midlands Choice Commercial |
$523.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$433.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$387.09
|
| Rate for Payer: United Healthcare Commercial |
$673.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$441.32
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
4863379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$673.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$673.20
|
| Rate for Payer: Aetna of IA Medicare |
$426.36
|
| Rate for Payer: Amerigroup Medicaid |
$431.45
|
| Rate for Payer: Amerigroup Medicare |
$339.97
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$561.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$336.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$427.26
|
| Rate for Payer: Medical Associates Commercial |
$561.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$336.60
|
| Rate for Payer: Midlands Choice Commercial |
$523.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$433.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$387.09
|
| Rate for Payer: United Healthcare Commercial |
$673.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$441.32
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$4,182.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
4863388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,881.90 |
| Max. Negotiated Rate |
$10,774.68 |
| Rate for Payer: Aetna of IA Commercial |
$3,763.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,763.80
|
| Rate for Payer: Aetna of IA Medicare |
$2,383.74
|
| Rate for Payer: Amerigroup Medicaid |
$2,412.18
|
| Rate for Payer: Amerigroup Medicare |
$1,900.72
|
| Rate for Payer: Cash Price |
$3,345.60
|
| Rate for Payer: Cash Price |
$3,345.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,136.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,881.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,388.76
|
| Rate for Payer: Medical Associates Commercial |
$3,136.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,881.90
|
| Rate for Payer: Midlands Choice Commercial |
$2,927.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,423.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,164.18
|
| Rate for Payer: United Healthcare Commercial |
$3,763.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,467.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$9,781.36
|
| Rate for Payer: Wellmark IA PPO |
$10,774.68
|
|
|
TREAT FINGER FRACTURE EACH
|
Professional
|
Both
|
$1,038.00
|
|
|
Service Code
|
CPT 26755
|
| Hospital Charge Code |
7982799
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$205.14 |
| Max. Negotiated Rate |
$778.50 |
| Rate for Payer: Amerigroup Medicaid |
$207.15
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Cash Price |
$830.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$205.14
|
| Rate for Payer: Medical Associates Commercial |
$778.50
|
| Rate for Payer: Midlands Choice Commercial |
$726.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$206.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$778.50
|
| Rate for Payer: United Healthcare Commercial |
$478.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$629.60
|
| Rate for Payer: Wellmark IA PPO |
$740.70
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
4863316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna of IA Commercial |
$673.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$673.20
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$561.00
|
| Rate for Payer: Medical Associates Commercial |
$561.00
|
| Rate for Payer: Midlands Choice Commercial |
$523.60
|
| Rate for Payer: United Healthcare Commercial |
$673.20
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
CPT 26725
|
| Hospital Charge Code |
4863316
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$336.60 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$673.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$673.20
|
| Rate for Payer: Aetna of IA Medicare |
$426.36
|
| Rate for Payer: Amerigroup Medicaid |
$431.45
|
| Rate for Payer: Amerigroup Medicare |
$339.97
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$561.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$336.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$427.26
|
| Rate for Payer: Medical Associates Commercial |
$561.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$336.60
|
| Rate for Payer: Midlands Choice Commercial |
$523.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$433.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$387.09
|
| Rate for Payer: United Healthcare Commercial |
$673.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$441.32
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREAT FINGER FRACTURE EACH
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
CPT 26720
|
| Hospital Charge Code |
4863309
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$523.60 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Aetna of IA Commercial |
$673.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$673.20
|
| Rate for Payer: Cash Price |
$598.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$561.00
|
| Rate for Payer: Medical Associates Commercial |
$561.00
|
| Rate for Payer: Midlands Choice Commercial |
$523.60
|
| Rate for Payer: United Healthcare Commercial |
$673.20
|
|
|
TREAT FOOT BONE LESION
|
Facility
|
OP
|
$4,699.00
|
|
|
Service Code
|
CPT 28005
|
| Hospital Charge Code |
7982939
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,114.55 |
| Max. Negotiated Rate |
$13,337.14 |
| Rate for Payer: Aetna of IA Commercial |
$4,229.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,229.10
|
| Rate for Payer: Aetna of IA Medicare |
$2,678.43
|
| Rate for Payer: Amerigroup Medicaid |
$2,710.38
|
| Rate for Payer: Amerigroup Medicare |
$2,135.70
|
| Rate for Payer: Cash Price |
$3,759.20
|
| Rate for Payer: Cash Price |
$3,759.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,524.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,114.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,684.07
|
| Rate for Payer: Medical Associates Commercial |
$3,524.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,114.55
|
| Rate for Payer: Midlands Choice Commercial |
$3,289.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,723.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,431.73
|
| Rate for Payer: United Healthcare Commercial |
$4,229.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,772.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$12,107.59
|
| Rate for Payer: Wellmark IA PPO |
$13,337.14
|
|
|
TREAT FOOT BONE LESION
|
Facility
|
IP
|
$4,699.00
|
|
|
Service Code
|
CPT 28005
|
| Hospital Charge Code |
7982939
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,289.30 |
| Max. Negotiated Rate |
$4,229.10 |
| Rate for Payer: Aetna of IA Commercial |
$4,229.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,229.10
|
| Rate for Payer: Cash Price |
$3,759.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,524.25
|
| Rate for Payer: Medical Associates Commercial |
$3,524.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,289.30
|
| Rate for Payer: United Healthcare Commercial |
$4,229.10
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
7983025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$879.20 |
| Max. Negotiated Rate |
$1,130.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,130.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$942.00
|
| Rate for Payer: Medical Associates Commercial |
$942.00
|
| Rate for Payer: Midlands Choice Commercial |
$879.20
|
| Rate for Payer: United Healthcare Commercial |
$1,130.40
|
|
|
TREAT FRACTURE OF RADIUS
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
7983025
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$565.20 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$1,130.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,130.40
|
| Rate for Payer: Aetna of IA Medicare |
$715.92
|
| Rate for Payer: Amerigroup Medicaid |
$724.46
|
| Rate for Payer: Amerigroup Medicare |
$570.85
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$942.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$565.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$717.43
|
| Rate for Payer: Medical Associates Commercial |
$942.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$565.20
|
| Rate for Payer: Midlands Choice Commercial |
$879.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$727.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$649.98
|
| Rate for Payer: United Healthcare Commercial |
$1,130.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$741.04
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREAT FRACTURE OF RADIUS
|
Professional
|
Both
|
$1,409.00
|
|
|
Service Code
|
CPT 25505
|
| Hospital Charge Code |
7982869
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$409.57 |
| Max. Negotiated Rate |
$1,172.20 |
| Rate for Payer: Amerigroup Medicaid |
$413.59
|
| Rate for Payer: Cash Price |
$1,127.20
|
| Rate for Payer: Cash Price |
$1,127.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$409.57
|
| Rate for Payer: Medical Associates Commercial |
$1,056.75
|
| Rate for Payer: Midlands Choice Commercial |
$986.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$411.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,056.75
|
| Rate for Payer: United Healthcare Commercial |
$758.86
|
| Rate for Payer: Wellmark IA HMO WHPI |
$996.30
|
| Rate for Payer: Wellmark IA PPO |
$1,172.20
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
7983020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$282.60 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$565.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$565.20
|
| Rate for Payer: Aetna of IA Medicare |
$357.96
|
| Rate for Payer: Amerigroup Medicaid |
$362.23
|
| Rate for Payer: Amerigroup Medicare |
$285.43
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$471.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$282.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$358.71
|
| Rate for Payer: Medical Associates Commercial |
$471.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$282.60
|
| Rate for Payer: Midlands Choice Commercial |
$439.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$363.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$324.99
|
| Rate for Payer: United Healthcare Commercial |
$565.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$370.52
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREAT FRACTURE OF ULNA
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 25535
|
| Hospital Charge Code |
7983020
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.60 |
| Max. Negotiated Rate |
$565.20 |
| Rate for Payer: Aetna of IA Commercial |
$565.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$565.20
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$471.00
|
| Rate for Payer: Medical Associates Commercial |
$471.00
|
| Rate for Payer: Midlands Choice Commercial |
$439.60
|
| Rate for Payer: United Healthcare Commercial |
$565.20
|
|
|
TREAT FRACTURE RADIUS ULNA
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
4864847
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$439.60 |
| Max. Negotiated Rate |
$565.20 |
| Rate for Payer: Aetna of IA Commercial |
$565.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$565.20
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$471.00
|
| Rate for Payer: Medical Associates Commercial |
$471.00
|
| Rate for Payer: Midlands Choice Commercial |
$439.60
|
| Rate for Payer: United Healthcare Commercial |
$565.20
|
|
|
TREAT FRACTURE RADIUS ULNA
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
4864848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$565.20 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$1,130.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,130.40
|
| Rate for Payer: Aetna of IA Medicare |
$715.92
|
| Rate for Payer: Amerigroup Medicaid |
$724.46
|
| Rate for Payer: Amerigroup Medicare |
$570.85
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$942.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$565.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$717.43
|
| Rate for Payer: Medical Associates Commercial |
$942.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$565.20
|
| Rate for Payer: Midlands Choice Commercial |
$879.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$727.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$649.98
|
| Rate for Payer: United Healthcare Commercial |
$1,130.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$741.04
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREAT FRACTURE RADIUS ULNA
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 25565
|
| Hospital Charge Code |
4864848
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$879.20 |
| Max. Negotiated Rate |
$1,130.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,130.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,130.40
|
| Rate for Payer: Cash Price |
$1,004.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$942.00
|
| Rate for Payer: Medical Associates Commercial |
$942.00
|
| Rate for Payer: Midlands Choice Commercial |
$879.20
|
| Rate for Payer: United Healthcare Commercial |
$1,130.40
|
|
|
TREAT FRACTURE RADIUS ULNA
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
4864847
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$282.60 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$565.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$565.20
|
| Rate for Payer: Aetna of IA Medicare |
$357.96
|
| Rate for Payer: Amerigroup Medicaid |
$362.23
|
| Rate for Payer: Amerigroup Medicare |
$285.43
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Cash Price |
$502.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$471.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$282.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$358.71
|
| Rate for Payer: Medical Associates Commercial |
$471.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$282.60
|
| Rate for Payer: Midlands Choice Commercial |
$439.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$363.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$324.99
|
| Rate for Payer: United Healthcare Commercial |
$565.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$370.52
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREAT FRACTURE RADIUS ULNA
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
CPT 25560
|
| Hospital Charge Code |
7982807
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$230.91 |
| Max. Negotiated Rate |
$690.00 |
| Rate for Payer: Amerigroup Medicaid |
$233.17
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Cash Price |
$736.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$230.91
|
| Rate for Payer: Medical Associates Commercial |
$690.00
|
| Rate for Payer: Midlands Choice Commercial |
$644.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$232.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$690.00
|
| Rate for Payer: United Healthcare Commercial |
$427.36
|
| Rate for Payer: Wellmark IA HMO WHPI |
$574.30
|
| Rate for Payer: Wellmark IA PPO |
$675.60
|
|
