|
ANUS SURGERY PROCEDURE
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
7982911
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,325.80 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,704.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,704.60
|
| Rate for Payer: Cash Price |
$1,515.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,420.50
|
| Rate for Payer: Medical Associates Commercial |
$1,420.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,325.80
|
| Rate for Payer: United Healthcare Commercial |
$1,704.60
|
|
|
ANUS SURGERY PROCEDURE
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
7982911
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$852.30 |
| Max. Negotiated Rate |
$4,161.95 |
| Rate for Payer: Aetna of IA Commercial |
$1,704.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,704.60
|
| Rate for Payer: Aetna of IA Medicare |
$1,079.58
|
| Rate for Payer: Amerigroup Medicaid |
$1,092.46
|
| Rate for Payer: Amerigroup Medicare |
$860.82
|
| Rate for Payer: Cash Price |
$1,515.20
|
| Rate for Payer: Cash Price |
$1,515.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,420.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$852.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,081.85
|
| Rate for Payer: Medical Associates Commercial |
$1,420.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$852.30
|
| Rate for Payer: Midlands Choice Commercial |
$1,325.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,097.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$980.14
|
| Rate for Payer: United Healthcare Commercial |
$1,704.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,117.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,778.26
|
| Rate for Payer: Wellmark IA PPO |
$4,161.95
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
|
IP
|
$58,769.24
|
|
|
Service Code
|
MSDRG 268
|
| Min. Negotiated Rate |
$57,917.49 |
| Max. Negotiated Rate |
$58,769.24 |
| Rate for Payer: Amerigroup Medicaid |
$58,485.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57,917.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58,769.24
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
|
IP
|
$33,435.89
|
|
|
Service Code
|
MSDRG 269
|
| Min. Negotiated Rate |
$32,951.29 |
| Max. Negotiated Rate |
$33,435.89 |
| Rate for Payer: Amerigroup Medicaid |
$33,274.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32,951.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33,435.89
|
|
|
APAP/butalbital/caffeine 325 mg-50 mg-40 mg Tab [VDMC]
|
Facility
|
OP
|
$1.53
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10367413
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| Rate for Payer: Aetna of IA Medicare |
$0.87
|
| Rate for Payer: Amerigroup Medicaid |
$0.88
|
| Rate for Payer: Amerigroup Medicare |
$0.69
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.87
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.69
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
APAP/butalbital/caffeine 325 mg-50 mg-40 mg Tab [VDMC]
|
Facility
|
IP
|
$1.53
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10367413
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.37 |
| Rate for Payer: Aetna of IA Commercial |
$1.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.37
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.14
|
| Rate for Payer: Medical Associates Commercial |
$1.14
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
|
|
apixaban 5 mg Tab UD [VDMC]
|
Facility
|
OP
|
$28.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10367482
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna of IA Commercial |
$26.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.00
|
| Rate for Payer: Aetna of IA Medicare |
$16.47
|
| Rate for Payer: Amerigroup Medicaid |
$16.66
|
| Rate for Payer: Amerigroup Medicare |
$13.13
|
| Rate for Payer: Cash Price |
$23.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.50
|
| Rate for Payer: Medical Associates Commercial |
$21.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.00
|
| Rate for Payer: Midlands Choice Commercial |
$20.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.95
|
| Rate for Payer: United Healthcare Commercial |
$26.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.04
|
|
|
apixaban 5 mg Tab UD [VDMC]
|
Facility
|
IP
|
$28.89
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10367482
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.22 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Aetna of IA Commercial |
$26.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.00
|
| Rate for Payer: Cash Price |
$23.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.66
|
| Rate for Payer: Medical Associates Commercial |
$21.66
|
| Rate for Payer: Midlands Choice Commercial |
$20.22
|
| Rate for Payer: United Healthcare Commercial |
$26.00
|
|
|
Apolipoprotein B DMCL
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
8938406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.75 |
| Max. Negotiated Rate |
$67.95 |
| Rate for Payer: Aetna of IA Commercial |
$67.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.50
|
| Rate for Payer: Aetna of IA Medicare |
$42.75
|
| Rate for Payer: Amerigroup Medicaid |
$43.26
|
| Rate for Payer: Amerigroup Medicare |
$34.09
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.84
|
| Rate for Payer: Medical Associates Commercial |
$56.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.75
|
| Rate for Payer: Midlands Choice Commercial |
$52.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.81
|
| Rate for Payer: United Healthcare Commercial |
$67.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.25
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
Apolipoprotein B DMCL
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
8938406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna of IA Commercial |
$67.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.50
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.25
|
| Rate for Payer: Medical Associates Commercial |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$52.50
|
| Rate for Payer: United Healthcare Commercial |
$67.50
|
|
|
APPLICATION LONG LEG SPLINT
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
7982786
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$88.72 |
| Max. Negotiated Rate |
$203.50 |
| Rate for Payer: Amerigroup Medicaid |
$89.59
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$88.72
|
| Rate for Payer: Medical Associates Commercial |
$163.50
|
| Rate for Payer: Midlands Choice Commercial |
$152.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$89.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$163.50
|
| Rate for Payer: United Healthcare Commercial |
$126.86
|
| Rate for Payer: Wellmark IA HMO WHPI |
$173.00
|
| Rate for Payer: Wellmark IA PPO |
$203.50
|
|
|
APPLICATION LOWER LEG SPLINT
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
7982785
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$76.10 |
| Max. Negotiated Rate |
$163.50 |
| Rate for Payer: Amerigroup Medicaid |
$76.85
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.10
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$76.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.75
|
| Rate for Payer: United Healthcare Commercial |
$106.13
|
| Rate for Payer: Wellmark IA HMO WHPI |
$139.00
|
| Rate for Payer: Wellmark IA PPO |
$163.50
|
|
|
APPLICATION OF FINGER SPLINT
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
7982788
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$94.70 |
| Rate for Payer: Amerigroup Medicaid |
$35.15
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.81
|
| Rate for Payer: Medical Associates Commercial |
$84.00
|
| Rate for Payer: Midlands Choice Commercial |
$78.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.00
|
| Rate for Payer: United Healthcare Commercial |
$61.97
|
| Rate for Payer: Wellmark IA HMO WHPI |
$80.50
|
| Rate for Payer: Wellmark IA PPO |
$94.70
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
4864878
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.05 |
| Max. Negotiated Rate |
$499.84 |
| Rate for Payer: Aetna of IA Commercial |
$206.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$206.10
|
| Rate for Payer: Aetna of IA Medicare |
$130.53
|
| Rate for Payer: Amerigroup Medicaid |
$132.09
|
| Rate for Payer: Amerigroup Medicare |
$104.08
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$171.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$130.80
|
| Rate for Payer: Medical Associates Commercial |
$171.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.05
|
| Rate for Payer: Midlands Choice Commercial |
$160.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$132.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$118.51
|
| Rate for Payer: United Healthcare Commercial |
$206.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$135.11
|
| Rate for Payer: Wellmark IA HMO WHPI |
$453.76
|
| Rate for Payer: Wellmark IA PPO |
$499.84
|
|
|
APPLICATION OF FOREARM CAST
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
4864878
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$206.10 |
| Rate for Payer: Aetna of IA Commercial |
$206.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$206.10
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$171.75
|
| Rate for Payer: Medical Associates Commercial |
$171.75
|
| Rate for Payer: Midlands Choice Commercial |
$160.30
|
| Rate for Payer: United Healthcare Commercial |
$206.10
|
|
|
APPLICATION OF LONG ARM CAST
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
4864876
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$206.10 |
| Rate for Payer: Aetna of IA Commercial |
$206.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$206.10
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$171.75
|
| Rate for Payer: Medical Associates Commercial |
$171.75
|
| Rate for Payer: Midlands Choice Commercial |
$160.30
|
| Rate for Payer: United Healthcare Commercial |
$206.10
|
|
|
APPLICATION OF LONG ARM CAST
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 29065
|
| Hospital Charge Code |
4864876
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.05 |
| Max. Negotiated Rate |
$499.84 |
| Rate for Payer: Aetna of IA Commercial |
$206.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$206.10
|
| Rate for Payer: Aetna of IA Medicare |
$130.53
|
| Rate for Payer: Amerigroup Medicaid |
$132.09
|
| Rate for Payer: Amerigroup Medicare |
$104.08
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$171.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$130.80
|
| Rate for Payer: Medical Associates Commercial |
$171.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.05
|
| Rate for Payer: Midlands Choice Commercial |
$160.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$132.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$118.51
|
| Rate for Payer: United Healthcare Commercial |
$206.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$135.11
|
| Rate for Payer: Wellmark IA HMO WHPI |
$453.76
|
| Rate for Payer: Wellmark IA PPO |
$499.84
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
4864890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.30 |
| Max. Negotiated Rate |
$206.10 |
| Rate for Payer: Aetna of IA Commercial |
$206.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$206.10
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$171.75
|
| Rate for Payer: Medical Associates Commercial |
$171.75
|
| Rate for Payer: Midlands Choice Commercial |
$160.30
|
| Rate for Payer: United Healthcare Commercial |
$206.10
|
|
|
APPLICATION OF LONG LEG CAST
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 29345
|
| Hospital Charge Code |
4864890
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.05 |
| Max. Negotiated Rate |
$499.84 |
| Rate for Payer: Aetna of IA Commercial |
$206.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$206.10
|
| Rate for Payer: Aetna of IA Medicare |
$130.53
|
| Rate for Payer: Amerigroup Medicaid |
$132.09
|
| Rate for Payer: Amerigroup Medicare |
$104.08
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$171.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$130.80
|
| Rate for Payer: Medical Associates Commercial |
$171.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.05
|
| Rate for Payer: Midlands Choice Commercial |
$160.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$132.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$118.51
|
| Rate for Payer: United Healthcare Commercial |
$206.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$135.11
|
| Rate for Payer: Wellmark IA HMO WHPI |
$453.76
|
| Rate for Payer: Wellmark IA PPO |
$499.84
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$3,434.06
|
|
|
Service Code
|
CPT 15275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,117.47 |
| Max. Negotiated Rate |
$3,434.06 |
| Rate for Payer: Wellmark IA HMO WHPI |
$3,117.47
|
| Rate for Payer: Wellmark IA PPO |
$3,434.06
|
|
|
APPLICATION TOTAL CONTACT CAST
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
8013707
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$182.70 |
| Max. Negotiated Rate |
$499.84 |
| Rate for Payer: Aetna of IA Commercial |
$365.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$365.40
|
| Rate for Payer: Aetna of IA Medicare |
$231.42
|
| Rate for Payer: Amerigroup Medicaid |
$234.18
|
| Rate for Payer: Amerigroup Medicare |
$184.53
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$304.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$182.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$231.91
|
| Rate for Payer: Medical Associates Commercial |
$304.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.70
|
| Rate for Payer: Midlands Choice Commercial |
$284.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$235.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$210.10
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$239.54
|
| Rate for Payer: Wellmark IA HMO WHPI |
$453.76
|
| Rate for Payer: Wellmark IA PPO |
$499.84
|
|
|
APPLICATION TOTAL CONTACT CAST
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
8013707
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna of IA Commercial |
$365.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$365.40
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$304.50
|
| Rate for Payer: Medical Associates Commercial |
$304.50
|
| Rate for Payer: Midlands Choice Commercial |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
|
|
APPL SKIN SUB < 100 1ST 25 CM FEET/TOES
|
Facility
|
OP
|
$569.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
8013703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$256.05 |
| Max. Negotiated Rate |
$3,434.06 |
| Rate for Payer: Aetna of IA Commercial |
$512.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$512.10
|
| Rate for Payer: Aetna of IA Medicare |
$324.33
|
| Rate for Payer: Amerigroup Medicaid |
$328.20
|
| Rate for Payer: Amerigroup Medicare |
$258.61
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$426.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$256.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$325.01
|
| Rate for Payer: Medical Associates Commercial |
$426.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$256.05
|
| Rate for Payer: Midlands Choice Commercial |
$398.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$329.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$294.46
|
| Rate for Payer: United Healthcare Commercial |
$512.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$335.71
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,117.47
|
| Rate for Payer: Wellmark IA PPO |
$3,434.06
|
|
|
APPL SKIN SUB < 100 1ST 25 CM FEET/TOES
|
Facility
|
IP
|
$569.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
8013703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$398.30 |
| Max. Negotiated Rate |
$512.10 |
| Rate for Payer: Aetna of IA Commercial |
$512.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$512.10
|
| Rate for Payer: Cash Price |
$455.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$426.75
|
| Rate for Payer: Medical Associates Commercial |
$426.75
|
| Rate for Payer: Midlands Choice Commercial |
$398.30
|
| Rate for Payer: United Healthcare Commercial |
$512.10
|
|
|
APPL SKIN SUB < 100 1ST 25 CM LEG/ANKLE
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
7438782
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$319.95 |
| Max. Negotiated Rate |
$3,434.06 |
| Rate for Payer: Aetna of IA Commercial |
$639.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$639.90
|
| Rate for Payer: Aetna of IA Medicare |
$405.27
|
| Rate for Payer: Amerigroup Medicaid |
$410.10
|
| Rate for Payer: Amerigroup Medicare |
$323.15
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Cash Price |
$568.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$533.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$319.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$406.12
|
| Rate for Payer: Medical Associates Commercial |
$533.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$319.95
|
| Rate for Payer: Midlands Choice Commercial |
$497.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$412.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$367.94
|
| Rate for Payer: United Healthcare Commercial |
$639.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$419.49
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,117.47
|
| Rate for Payer: Wellmark IA PPO |
$3,434.06
|
|
