|
10060 ID ABSCESS SIMPLE
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
8799068
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$97.80 |
| Max. Negotiated Rate |
$210.84 |
| Rate for Payer: Aetna of IA Medicare |
$97.80
|
| Rate for Payer: Amerigroup Medicaid |
$101.13
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$99.76
|
| Rate for Payer: Medical Associates Commercial |
$185.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$97.80
|
| Rate for Payer: Midlands Choice Commercial |
$210.84
|
| Rate for Payer: Oscar Health of IA Commercial |
$169.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$146.70
|
|
|
10061 ID ABSCESS COMPLEX
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
8799069
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.42 |
| Max. Negotiated Rate |
$485.10 |
| Rate for Payer: Aetna of IA Medicare |
$168.42
|
| Rate for Payer: Amerigroup Medicaid |
$174.15
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.79
|
| Rate for Payer: Medical Associates Commercial |
$320.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$168.42
|
| Rate for Payer: Midlands Choice Commercial |
$485.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$291.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$252.63
|
|
|
10061 ID ABSCESS COMPLEX/MULTIPLE
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
8069020
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$168.42 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna of IA Medicare |
$168.42
|
| Rate for Payer: Amerigroup Medicaid |
$174.15
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$202.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.79
|
| Rate for Payer: Medical Associates Commercial |
$320.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$168.42
|
| Rate for Payer: Midlands Choice Commercial |
$478.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$291.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$252.63
|
|
|
10080 ID pilonidal cyst
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
8799070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$95.56 |
| Max. Negotiated Rate |
$206.50 |
| Rate for Payer: Aetna of IA Medicare |
$95.56
|
| Rate for Payer: Amerigroup Medicaid |
$98.81
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.47
|
| Rate for Payer: Medical Associates Commercial |
$181.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.56
|
| Rate for Payer: Midlands Choice Commercial |
$206.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$165.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.34
|
|
|
10120 ID FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$504.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
8799071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$352.80 |
| Rate for Payer: Aetna of IA Medicare |
$96.60
|
| Rate for Payer: Amerigroup Medicaid |
$99.88
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.53
|
| Rate for Payer: Medical Associates Commercial |
$183.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$96.60
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$167.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$144.90
|
|
|
10121 ID SIMPLE
|
Professional
|
Both
|
$906.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
8069115
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.86 |
| Max. Negotiated Rate |
$634.20 |
| Rate for Payer: Aetna of IA Medicare |
$166.86
|
| Rate for Payer: Amerigroup Medicaid |
$172.53
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$200.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$170.20
|
| Rate for Payer: Medical Associates Commercial |
$317.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.86
|
| Rate for Payer: Midlands Choice Commercial |
$634.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$288.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$250.29
|
|
|
10140 ID HEMATOMA/SEROMA/FLUID
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
8069092
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$108.09 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Aetna of IA Medicare |
$108.09
|
| Rate for Payer: Amerigroup Medicaid |
$111.77
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$129.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$110.25
|
| Rate for Payer: Medical Associates Commercial |
$205.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$108.09
|
| Rate for Payer: Midlands Choice Commercial |
$378.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$187.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$162.14
|
|
|
10180 ID CPLX POST OP WOUND INFECTION
|
Professional
|
Both
|
$816.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
8068952
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$160.07 |
| Max. Negotiated Rate |
$571.20 |
| Rate for Payer: Aetna of IA Medicare |
$160.07
|
| Rate for Payer: Amerigroup Medicaid |
$165.51
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Cash Price |
$652.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$192.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$163.27
|
| Rate for Payer: Medical Associates Commercial |
$304.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$160.07
|
| Rate for Payer: Midlands Choice Commercial |
$571.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$276.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$240.10
|
|
|
1.0CC VISCOUS
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8781515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,386.00 |
| Max. Negotiated Rate |
$1,782.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,782.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,782.00
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,485.00
|
| Rate for Payer: Medical Associates Commercial |
$1,485.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,386.00
|
| Rate for Payer: United Healthcare Commercial |
$1,782.00
|
|
|
1.0CC VISCOUS
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8781515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.60 |
| Max. Negotiated Rate |
$1,782.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,782.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,782.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,128.60
|
| Rate for Payer: Amerigroup Medicaid |
$999.31
|
| Rate for Payer: Amerigroup Medicare |
$999.90
|
| Rate for Payer: Cash Price |
$1,584.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,485.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$990.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$989.60
|
| Rate for Payer: Medical Associates Commercial |
$1,485.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$990.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,386.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,004.85
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,004.26
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,485.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,485.00
|
| Rate for Payer: United Healthcare Commercial |
$1,782.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,168.20
|
|
|
10 HOLE LATERAL FIBULA PLATE SYMMETRIC
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8895427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.00 |
| Max. Negotiated Rate |
$2,227.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,227.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,227.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,410.75
|
| Rate for Payer: Amerigroup Medicaid |
$1,249.13
|
| Rate for Payer: Amerigroup Medicare |
$1,249.88
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,856.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,237.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,237.00
|
| Rate for Payer: Medical Associates Commercial |
$1,856.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,237.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,732.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,256.06
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,255.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,856.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,856.25
|
| Rate for Payer: United Healthcare Commercial |
$2,227.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,460.25
|
|
|
10 HOLE LATERAL FIBULA PLATE SYMMETRIC
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8895427
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,732.50 |
| Max. Negotiated Rate |
$2,227.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,227.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,227.50
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,856.25
|
| Rate for Payer: Medical Associates Commercial |
$1,856.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,732.50
|
| Rate for Payer: United Healthcare Commercial |
$2,227.50
|
|
|
11008 REMOVAL MESH ABDOMINAL WALL
|
Professional
|
Both
|
$930.00
|
|
|
Service Code
|
CPT 11008
|
| Hospital Charge Code |
8069116
|
| Min. Negotiated Rate |
$237.43 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Amerigroup Medicaid |
$245.50
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Cash Price |
$744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$284.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$242.18
|
| Rate for Payer: Medical Associates Commercial |
$697.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$237.43
|
| Rate for Payer: Midlands Choice Commercial |
$651.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$410.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$356.14
|
|
|
11042 SUBQ TISSUE FIRST 20 SQ CM
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
CPT 11042
|
| Hospital Charge Code |
8799072
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.05 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Aetna of IA Medicare |
$55.05
|
| Rate for Payer: Amerigroup Medicaid |
$56.92
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.15
|
| Rate for Payer: Medical Associates Commercial |
$104.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.05
|
| Rate for Payer: Midlands Choice Commercial |
$129.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$95.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.58
|
|
|
11043 SUBQ MUSCLE FIRST 20 SQ CM
|
Professional
|
Both
|
$771.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
8799073
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$539.70 |
| Rate for Payer: Aetna of IA Medicare |
$138.64
|
| Rate for Payer: Amerigroup Medicaid |
$143.35
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$166.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$141.41
|
| Rate for Payer: Medical Associates Commercial |
$263.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$138.64
|
| Rate for Payer: Midlands Choice Commercial |
$539.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$239.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$207.96
|
|
|
11044 SUBQ MUSCLE BONE FIRST 20 SQ CM
|
Professional
|
Both
|
$1,041.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
8799226
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$728.70 |
| Rate for Payer: Aetna of IA Medicare |
$202.72
|
| Rate for Payer: Amerigroup Medicaid |
$209.61
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$243.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$206.77
|
| Rate for Payer: Medical Associates Commercial |
$385.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$202.72
|
| Rate for Payer: Midlands Choice Commercial |
$728.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$350.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$304.08
|
|
|
11045 SUBQ TISSUE EA ADD'L 20 SQ CM
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 11045
|
| Hospital Charge Code |
8799074
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$22.65 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna of IA Medicare |
$22.65
|
| Rate for Payer: Amerigroup Medicaid |
$23.42
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.10
|
| Rate for Payer: Medical Associates Commercial |
$43.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.65
|
| Rate for Payer: Midlands Choice Commercial |
$96.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$39.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.98
|
|
|
11046 SUBQ MUSCLE EA ADD'L 20 SQ CM
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
8799075
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$48.83 |
| Max. Negotiated Rate |
$172.20 |
| Rate for Payer: Aetna of IA Medicare |
$48.83
|
| Rate for Payer: Amerigroup Medicaid |
$50.49
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.81
|
| Rate for Payer: Medical Associates Commercial |
$92.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.83
|
| Rate for Payer: Midlands Choice Commercial |
$172.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$84.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$73.24
|
|
|
11055 PARING OF CORN/CALLUS
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
8799076
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$14.30 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Medicare |
$14.30
|
| Rate for Payer: Amerigroup Medicaid |
$14.79
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.59
|
| Rate for Payer: Medical Associates Commercial |
$27.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.30
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.45
|
|
|
11200 REMOVAL OF SKIN TAGS MULTIPLE FIBROCUTANEOUS TAGS ANY AREA UP TO 15 LESIONS
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
8799077
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$70.05 |
| Max. Negotiated Rate |
$159.81 |
| Rate for Payer: Aetna of IA Medicare |
$70.05
|
| Rate for Payer: Amerigroup Medicaid |
$72.43
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.45
|
| Rate for Payer: Medical Associates Commercial |
$133.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.05
|
| Rate for Payer: Midlands Choice Commercial |
$159.81
|
| Rate for Payer: Oscar Health of IA Commercial |
$121.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.08
|
|
|
11300 Shaving of lesion- trunk arms legs 0.5 cm or less
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
8799078
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$30.86 |
| Max. Negotiated Rate |
$61.18 |
| Rate for Payer: Aetna of IA Medicare |
$30.86
|
| Rate for Payer: Amerigroup Medicaid |
$31.91
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.48
|
| Rate for Payer: Medical Associates Commercial |
$58.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.86
|
| Rate for Payer: Midlands Choice Commercial |
$61.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$53.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.29
|
|
|
11301 shave skin lesion
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
8799079
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$46.51 |
| Max. Negotiated Rate |
$91.13 |
| Rate for Payer: Aetna of IA Medicare |
$46.51
|
| Rate for Payer: Amerigroup Medicaid |
$48.09
|
| Rate for Payer: Cash Price |
$321.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.81
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.44
|
| Rate for Payer: Medical Associates Commercial |
$88.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.51
|
| Rate for Payer: Midlands Choice Commercial |
$91.13
|
| Rate for Payer: Oscar Health of IA Commercial |
$80.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.76
|
|
|
11400 Excision benign lesion- trunk arms legs less than 0.5 cm
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
CPT 11400
|
| Hospital Charge Code |
8799081
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$77.01 |
| Max. Negotiated Rate |
$292.60 |
| Rate for Payer: Aetna of IA Medicare |
$77.01
|
| Rate for Payer: Amerigroup Medicaid |
$79.63
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Cash Price |
$334.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.55
|
| Rate for Payer: Medical Associates Commercial |
$146.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$77.01
|
| Rate for Payer: Midlands Choice Commercial |
$292.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$133.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$115.52
|
|
|
11401 Excision benign lesion- trunk arms legs 0.6-1.0 cm
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
CPT 11401
|
| Hospital Charge Code |
8799082
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$96.62 |
| Max. Negotiated Rate |
$223.56 |
| Rate for Payer: Aetna of IA Medicare |
$96.62
|
| Rate for Payer: Amerigroup Medicaid |
$99.91
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.55
|
| Rate for Payer: Medical Associates Commercial |
$183.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$96.62
|
| Rate for Payer: Midlands Choice Commercial |
$223.56
|
| Rate for Payer: Oscar Health of IA Commercial |
$167.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$144.93
|
|
|
11402 Excision benign lesion- trunk arms legs 1.1 to 2.0 cm
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
CPT 11402
|
| Hospital Charge Code |
8799083
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$105.63 |
| Max. Negotiated Rate |
$246.30 |
| Rate for Payer: Aetna of IA Medicare |
$105.63
|
| Rate for Payer: Amerigroup Medicaid |
$109.22
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$126.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.74
|
| Rate for Payer: Medical Associates Commercial |
$200.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$105.63
|
| Rate for Payer: Midlands Choice Commercial |
$246.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$182.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.44
|
|
