|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
4864851
|
|
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 RADIUS/ULNA
|
Professional
|
Both
|
$1,087.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
7982806
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$253.10 |
| Max. Negotiated Rate |
$815.25 |
| Rate for Payer: Amerigroup Medicaid |
$255.58
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Cash Price |
$869.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$253.10
|
| Rate for Payer: Medical Associates Commercial |
$815.25
|
| Rate for Payer: Midlands Choice Commercial |
$760.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$254.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$815.25
|
| Rate for Payer: United Healthcare Commercial |
$498.50
|
| Rate for Payer: Wellmark IA HMO WHPI |
$669.30
|
| Rate for Payer: Wellmark IA PPO |
$787.40
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
4864850
|
|
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
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
4864851
|
|
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 RADIUS/ULNA
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
CPT 25605
|
| Hospital Charge Code |
7982805
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$447.76 |
| Max. Negotiated Rate |
$1,353.75 |
| Rate for Payer: Amerigroup Medicaid |
$452.15
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$447.76
|
| Rate for Payer: Medical Associates Commercial |
$1,353.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,263.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$449.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,353.75
|
| Rate for Payer: United Healthcare Commercial |
$814.96
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,054.80
|
| Rate for Payer: Wellmark IA PPO |
$1,241.00
|
|
|
TREAT FRACTURE RADIUS/ULNA
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 25600
|
| Hospital Charge Code |
4864850
|
|
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 HAND DISLOCATION
|
Facility
|
OP
|
$3,510.00
|
|
|
Service Code
|
CPT 26686
|
| Hospital Charge Code |
7982927
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,579.50 |
| Max. Negotiated Rate |
$10,774.68 |
| Rate for Payer: Aetna of IA Commercial |
$3,159.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,159.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,000.70
|
| Rate for Payer: Amerigroup Medicaid |
$2,024.57
|
| Rate for Payer: Amerigroup Medicare |
$1,595.30
|
| Rate for Payer: Cash Price |
$2,808.00
|
| Rate for Payer: Cash Price |
$2,808.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,632.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,579.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,004.91
|
| Rate for Payer: Medical Associates Commercial |
$2,632.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,579.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,457.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,034.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,816.42
|
| Rate for Payer: United Healthcare Commercial |
$3,159.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,070.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$9,781.36
|
| Rate for Payer: Wellmark IA PPO |
$10,774.68
|
|
|
TREAT HAND DISLOCATION
|
Facility
|
IP
|
$3,510.00
|
|
|
Service Code
|
CPT 26686
|
| Hospital Charge Code |
7982927
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,457.00 |
| Max. Negotiated Rate |
$3,159.00 |
| Rate for Payer: Aetna of IA Commercial |
$3,159.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,159.00
|
| Rate for Payer: Cash Price |
$2,808.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,632.50
|
| Rate for Payer: Medical Associates Commercial |
$2,632.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,457.00
|
| Rate for Payer: United Healthcare Commercial |
$3,159.00
|
|
|
TREAT HAND DISLOCATION
|
Professional
|
Both
|
$2,085.00
|
|
|
Service Code
|
CPT 26686
|
| Hospital Charge Code |
7982867
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$1,563.75 |
| Rate for Payer: Amerigroup Medicaid |
$550.63
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Cash Price |
$1,668.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$545.28
|
| Rate for Payer: Medical Associates Commercial |
$1,563.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,459.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$547.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,563.75
|
| Rate for Payer: United Healthcare Commercial |
$941.14
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,196.40
|
| Rate for Payer: Wellmark IA PPO |
$1,407.50
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$1,393.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
4864789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$975.10 |
| Max. Negotiated Rate |
$1,253.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,253.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,253.70
|
| Rate for Payer: Cash Price |
$1,114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,044.75
|
| Rate for Payer: Medical Associates Commercial |
$1,044.75
|
| Rate for Payer: Midlands Choice Commercial |
$975.10
|
| Rate for Payer: United Healthcare Commercial |
$1,253.70
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
4864782
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.30 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$678.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$678.60
|
| Rate for Payer: Aetna of IA Medicare |
$429.78
|
| Rate for Payer: Amerigroup Medicaid |
$434.91
|
| Rate for Payer: Amerigroup Medicare |
$342.69
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$565.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$339.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$430.68
|
| Rate for Payer: Medical Associates Commercial |
$565.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$339.30
|
| Rate for Payer: Midlands Choice Commercial |
$527.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$437.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$390.20
|
| Rate for Payer: United Healthcare Commercial |
$678.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$444.86
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
4863441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$388.80 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$777.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$777.60
|
| Rate for Payer: Aetna of IA Medicare |
$492.48
|
| Rate for Payer: Amerigroup Medicaid |
$498.36
|
| Rate for Payer: Amerigroup Medicare |
$392.69
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$648.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$388.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$493.52
|
| Rate for Payer: Medical Associates Commercial |
$648.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$388.80
|
| Rate for Payer: Midlands Choice Commercial |
$604.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$500.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$447.12
|
| Rate for Payer: United Healthcare Commercial |
$777.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$509.76
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
OP
|
$1,393.00
|
|
|
Service Code
|
CPT 27266
|
| Hospital Charge Code |
4864789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$626.85 |
| Max. Negotiated Rate |
$2,696.01 |
| Rate for Payer: Aetna of IA Commercial |
$1,253.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,253.70
|
| Rate for Payer: Aetna of IA Medicare |
$794.01
|
| Rate for Payer: Amerigroup Medicaid |
$803.48
|
| Rate for Payer: Amerigroup Medicare |
$633.12
|
| Rate for Payer: Cash Price |
$1,114.40
|
| Rate for Payer: Cash Price |
$1,114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,044.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$626.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$795.68
|
| Rate for Payer: Medical Associates Commercial |
$1,044.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$626.85
|
| Rate for Payer: Midlands Choice Commercial |
$975.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$807.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$720.88
|
| Rate for Payer: United Healthcare Commercial |
$1,253.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$821.87
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,447.47
|
| Rate for Payer: Wellmark IA PPO |
$2,696.01
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT 27265
|
| Hospital Charge Code |
4864782
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$527.80 |
| Max. Negotiated Rate |
$678.60 |
| Rate for Payer: Aetna of IA Commercial |
$678.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$678.60
|
| Rate for Payer: Cash Price |
$603.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$565.50
|
| Rate for Payer: Medical Associates Commercial |
$565.50
|
| Rate for Payer: Midlands Choice Commercial |
$527.80
|
| Rate for Payer: United Healthcare Commercial |
$678.60
|
|
|
TREAT HIP DISLOCATION
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 27250
|
| Hospital Charge Code |
4863441
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$604.80 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Aetna of IA Commercial |
$777.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$777.60
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$648.00
|
| Rate for Payer: Medical Associates Commercial |
$648.00
|
| Rate for Payer: Midlands Choice Commercial |
$604.80
|
| Rate for Payer: United Healthcare Commercial |
$777.60
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
4864827
|
|
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 HUMERUS FRACTURE
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
4864815
|
|
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 HUMERUS FRACTURE
|
Professional
|
Both
|
$1,254.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
7982812
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$322.59 |
| Max. Negotiated Rate |
$940.50 |
| Rate for Payer: Amerigroup Medicaid |
$325.75
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$322.59
|
| Rate for Payer: Medical Associates Commercial |
$940.50
|
| Rate for Payer: Midlands Choice Commercial |
$877.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$324.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$940.50
|
| Rate for Payer: United Healthcare Commercial |
$572.94
|
| Rate for Payer: Wellmark IA HMO WHPI |
$757.90
|
| Rate for Payer: Wellmark IA PPO |
$891.70
|
|
|
TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 23605
|
| Hospital Charge Code |
4864815
|
|
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 HUMERUS FRACTURE
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
4864817
|
|
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 HUMERUS FRACTURE
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
4864817
|
|
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 HUMERUS FRACTURE
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
4864825
|
|
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 HUMERUS FRACTURE
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 24500
|
| Hospital Charge Code |
4864825
|
|
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 HUMERUS FRACTURE
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
4864827
|
|
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 HUMERUS FRACTURE
|
Professional
|
Both
|
$1,657.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
7982809
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$441.64 |
| Max. Negotiated Rate |
$1,242.75 |
| Rate for Payer: Amerigroup Medicaid |
$445.97
|
| Rate for Payer: Cash Price |
$1,325.60
|
| Rate for Payer: Cash Price |
$1,325.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$441.64
|
| Rate for Payer: Medical Associates Commercial |
$1,242.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,159.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$443.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,242.75
|
| Rate for Payer: United Healthcare Commercial |
$750.69
|
| Rate for Payer: Wellmark IA HMO WHPI |
$987.50
|
| Rate for Payer: Wellmark IA PPO |
$1,161.80
|
|
