|
TREATMENT OF PENIS LESION
|
Facility
|
OP
|
$2,213.00
|
|
|
Service Code
|
CPT 54115
|
| Hospital Charge Code |
7982920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$995.85 |
| Max. Negotiated Rate |
$3,601.97 |
| Rate for Payer: Aetna of IA Commercial |
$1,991.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,991.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,261.41
|
| Rate for Payer: Amerigroup Medicaid |
$1,276.46
|
| Rate for Payer: Amerigroup Medicare |
$1,005.81
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$995.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,264.07
|
| Rate for Payer: Medical Associates Commercial |
$1,659.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$995.85
|
| Rate for Payer: Midlands Choice Commercial |
$1,549.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,282.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,145.23
|
| Rate for Payer: United Healthcare Commercial |
$1,991.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,305.67
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,269.91
|
| Rate for Payer: Wellmark IA PPO |
$3,601.97
|
|
|
TREATMENT OF PENIS LESION
|
Facility
|
IP
|
$2,213.00
|
|
|
Service Code
|
CPT 54115
|
| Hospital Charge Code |
7982920
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,549.10 |
| Max. Negotiated Rate |
$1,991.70 |
| Rate for Payer: Aetna of IA Commercial |
$1,991.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,991.70
|
| Rate for Payer: Cash Price |
$1,770.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,659.75
|
| Rate for Payer: Medical Associates Commercial |
$1,659.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,549.10
|
| Rate for Payer: United Healthcare Commercial |
$1,991.70
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
OP
|
$1,339.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
4864863
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.55 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$1,205.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,205.10
|
| Rate for Payer: Aetna of IA Medicare |
$763.23
|
| Rate for Payer: Amerigroup Medicaid |
$772.34
|
| Rate for Payer: Amerigroup Medicare |
$608.58
|
| Rate for Payer: Cash Price |
$1,071.20
|
| Rate for Payer: Cash Price |
$1,071.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,004.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$602.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$764.84
|
| Rate for Payer: Medical Associates Commercial |
$1,004.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$602.55
|
| Rate for Payer: Midlands Choice Commercial |
$937.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$776.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$692.93
|
| Rate for Payer: United Healthcare Commercial |
$1,205.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$790.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREATMENT OF TOE FRACTURE
|
Facility
|
IP
|
$1,339.00
|
|
|
Service Code
|
CPT 28515
|
| Hospital Charge Code |
4864863
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$937.30 |
| Max. Negotiated Rate |
$1,205.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,205.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,205.10
|
| Rate for Payer: Cash Price |
$1,071.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,004.25
|
| Rate for Payer: Medical Associates Commercial |
$1,004.25
|
| Rate for Payer: Midlands Choice Commercial |
$937.30
|
| Rate for Payer: United Healthcare Commercial |
$1,205.10
|
|
|
TREAT METACARPAL FRACTURE
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
4864869
|
|
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 METACARPAL FRACTURE
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
4864869
|
|
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 METACARPAL FRACTURE
|
Professional
|
Both
|
$858.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
7982803
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$198.27 |
| Max. Negotiated Rate |
$700.80 |
| Rate for Payer: Amerigroup Medicaid |
$200.21
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$198.27
|
| Rate for Payer: Medical Associates Commercial |
$643.50
|
| Rate for Payer: Midlands Choice Commercial |
$600.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$199.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$643.50
|
| Rate for Payer: United Healthcare Commercial |
$445.74
|
| Rate for Payer: Wellmark IA HMO WHPI |
$595.70
|
| Rate for Payer: Wellmark IA PPO |
$700.80
|
|
|
TREAT SHOULDER DISLOCATION
|
Professional
|
Both
|
$1,251.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
7982810
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$287.81 |
| Max. Negotiated Rate |
$938.25 |
| Rate for Payer: Amerigroup Medicaid |
$290.64
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$287.81
|
| Rate for Payer: Medical Associates Commercial |
$938.25
|
| Rate for Payer: Midlands Choice Commercial |
$875.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$289.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$938.25
|
| Rate for Payer: United Healthcare Commercial |
$609.81
|
| Rate for Payer: Wellmark IA HMO WHPI |
$792.50
|
| Rate for Payer: Wellmark IA PPO |
$932.40
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$686.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
4864819
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$617.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$617.40
|
| Rate for Payer: Aetna of IA Medicare |
$391.02
|
| Rate for Payer: Amerigroup Medicaid |
$395.68
|
| Rate for Payer: Amerigroup Medicare |
$311.79
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$514.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$308.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$391.84
|
| Rate for Payer: Medical Associates Commercial |
$514.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$308.70
|
| Rate for Payer: Midlands Choice Commercial |
$480.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$397.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$355.00
|
| Rate for Payer: United Healthcare Commercial |
$617.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$404.74
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$1,169.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
4864821
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$818.30 |
| Max. Negotiated Rate |
$1,052.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,052.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,052.10
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$876.75
|
| Rate for Payer: Medical Associates Commercial |
$876.75
|
| Rate for Payer: Midlands Choice Commercial |
$818.30
|
| Rate for Payer: United Healthcare Commercial |
$1,052.10
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
OP
|
$1,169.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
4864821
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$526.05 |
| Max. Negotiated Rate |
$2,696.01 |
| Rate for Payer: Aetna of IA Commercial |
$1,052.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,052.10
|
| Rate for Payer: Aetna of IA Medicare |
$666.33
|
| Rate for Payer: Amerigroup Medicaid |
$674.28
|
| Rate for Payer: Amerigroup Medicare |
$531.31
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Cash Price |
$935.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$876.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$526.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$667.73
|
| Rate for Payer: Medical Associates Commercial |
$876.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$526.05
|
| Rate for Payer: Midlands Choice Commercial |
$818.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$677.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$604.96
|
| Rate for Payer: United Healthcare Commercial |
$1,052.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$689.71
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,447.47
|
| Rate for Payer: Wellmark IA PPO |
$2,696.01
|
|
|
TREAT SHOULDER DISLOCATION
|
Facility
|
IP
|
$686.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
4864819
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$480.20 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna of IA Commercial |
$617.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$617.40
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$514.50
|
| Rate for Payer: Medical Associates Commercial |
$514.50
|
| Rate for Payer: Midlands Choice Commercial |
$480.20
|
| Rate for Payer: United Healthcare Commercial |
$617.40
|
|
|
TREAT SHOULDER DISLOCATION
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
7982811
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$240.69 |
| Max. Negotiated Rate |
$780.00 |
| Rate for Payer: Amerigroup Medicaid |
$243.05
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$240.69
|
| Rate for Payer: Medical Associates Commercial |
$780.00
|
| Rate for Payer: Midlands Choice Commercial |
$728.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$241.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$780.00
|
| Rate for Payer: United Healthcare Commercial |
$481.06
|
| Rate for Payer: Wellmark IA HMO WHPI |
$655.40
|
| Rate for Payer: Wellmark IA PPO |
$771.10
|
|
|
TREAT THUMB DISLOCATION
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
4860782
|
|
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 THUMB DISLOCATION
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
7982802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$296.34 |
| Max. Negotiated Rate |
$968.70 |
| Rate for Payer: Amerigroup Medicaid |
$299.25
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$296.34
|
| Rate for Payer: Medical Associates Commercial |
$932.25
|
| Rate for Payer: Midlands Choice Commercial |
$870.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$297.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$932.25
|
| Rate for Payer: United Healthcare Commercial |
$576.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$823.40
|
| Rate for Payer: Wellmark IA PPO |
$968.70
|
|
|
TREAT THUMB DISLOCATION
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
4860782
|
|
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 TOE DISLOCATION
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
7982791
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$120.79 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Amerigroup Medicaid |
$121.97
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$120.79
|
| Rate for Payer: Medical Associates Commercial |
$207.75
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$121.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$207.75
|
| Rate for Payer: United Healthcare Commercial |
$179.57
|
| Rate for Payer: Wellmark IA HMO WHPI |
$242.80
|
| Rate for Payer: Wellmark IA PPO |
$285.60
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
4864873
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$349.30 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Aetna of IA Commercial |
$449.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$449.10
|
| Rate for Payer: Cash Price |
$399.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$374.25
|
| Rate for Payer: Medical Associates Commercial |
$374.25
|
| Rate for Payer: Midlands Choice Commercial |
$349.30
|
| Rate for Payer: United Healthcare Commercial |
$449.10
|
|
|
TREAT TOE DISLOCATION
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
4864873
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.55 |
| Max. Negotiated Rate |
$2,009.51 |
| Rate for Payer: Aetna of IA Commercial |
$449.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$449.10
|
| Rate for Payer: Aetna of IA Medicare |
$284.43
|
| Rate for Payer: Amerigroup Medicaid |
$287.82
|
| Rate for Payer: Amerigroup Medicare |
$226.80
|
| Rate for Payer: Cash Price |
$399.20
|
| Rate for Payer: Cash Price |
$399.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$374.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$224.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$285.03
|
| Rate for Payer: Medical Associates Commercial |
$374.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$224.55
|
| Rate for Payer: Midlands Choice Commercial |
$349.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$289.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$258.23
|
| Rate for Payer: United Healthcare Commercial |
$449.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$294.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,824.26
|
| Rate for Payer: Wellmark IA PPO |
$2,009.51
|
|
|
TREAT WRIST BONE FRACTURE
|
Facility
|
IP
|
$628.00
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
7983035
|
|
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 WRIST BONE FRACTURE
|
Facility
|
OP
|
$628.00
|
|
|
Service Code
|
CPT 25630
|
| Hospital Charge Code |
7983035
|
|
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 WRIST DISLOCATION
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
4864857
|
|
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 WRIST DISLOCATION
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 25675
|
| Hospital Charge Code |
4864857
|
|
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
|
|
|
Treponemal Antibodies IgG/IgM DMCL
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
8481982
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
Treponemal Antibodies IgG/IgM DMCL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
8481982
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$65.76
|
| Rate for Payer: Amerigroup Medicare |
$51.81
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.12
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.30
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.00
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
