|
doxycycline hyclate 100 mg Tab [VDMC]
|
Facility
|
IP
|
$1.35
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
12634860
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.21 |
| Rate for Payer: Aetna of IA Commercial |
$1.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.21
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.01
|
| Rate for Payer: Medical Associates Commercial |
$1.01
|
| Rate for Payer: Midlands Choice Commercial |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$1.21
|
|
|
DRAINAGE MOUTH ROOF LESION
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
7982990
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna of IA Commercial |
$594.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$594.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$495.00
|
| Rate for Payer: Medical Associates Commercial |
$495.00
|
| Rate for Payer: Midlands Choice Commercial |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$594.00
|
|
|
DRAINAGE MOUTH ROOF LESION
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 42000
|
| Hospital Charge Code |
7982990
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna of IA Commercial |
$594.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$594.00
|
| Rate for Payer: Aetna of IA Medicare |
$376.20
|
| Rate for Payer: Amerigroup Medicaid |
$380.69
|
| Rate for Payer: Amerigroup Medicare |
$299.97
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$495.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$297.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$376.99
|
| Rate for Payer: Medical Associates Commercial |
$495.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$297.00
|
| Rate for Payer: Midlands Choice Commercial |
$462.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$382.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$341.55
|
| Rate for Payer: United Healthcare Commercial |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$389.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$336.78
|
| Rate for Payer: Wellmark IA PPO |
$370.98
|
|
|
DRAINAGE OF ARM BURSA
|
Facility
|
OP
|
$2,068.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
4864822
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$930.60 |
| Max. Negotiated Rate |
$4,029.18 |
| Rate for Payer: Aetna of IA Commercial |
$1,861.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,861.20
|
| Rate for Payer: Aetna of IA Medicare |
$1,178.76
|
| Rate for Payer: Amerigroup Medicaid |
$1,192.82
|
| Rate for Payer: Amerigroup Medicare |
$939.91
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,551.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$930.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,181.24
|
| Rate for Payer: Medical Associates Commercial |
$1,551.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$930.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,447.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,198.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,070.19
|
| Rate for Payer: United Healthcare Commercial |
$1,861.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,220.12
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,657.73
|
| Rate for Payer: Wellmark IA PPO |
$4,029.18
|
|
|
DRAINAGE OF ARM BURSA
|
Facility
|
IP
|
$2,068.00
|
|
|
Service Code
|
CPT 23931
|
| Hospital Charge Code |
4864822
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$1,861.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,861.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,861.20
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,551.00
|
| Rate for Payer: Medical Associates Commercial |
$1,551.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,447.60
|
| Rate for Payer: United Healthcare Commercial |
$1,861.20
|
|
|
DRAINAGE OF ARM LESION
|
Facility
|
OP
|
$2,068.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
7982940
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$930.60 |
| Max. Negotiated Rate |
$4,029.18 |
| Rate for Payer: Aetna of IA Commercial |
$1,861.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,861.20
|
| Rate for Payer: Aetna of IA Medicare |
$1,178.76
|
| Rate for Payer: Amerigroup Medicaid |
$1,192.82
|
| Rate for Payer: Amerigroup Medicare |
$939.91
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,551.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$930.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,181.24
|
| Rate for Payer: Medical Associates Commercial |
$1,551.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$930.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,447.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,198.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,070.19
|
| Rate for Payer: United Healthcare Commercial |
$1,861.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,220.12
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,657.73
|
| Rate for Payer: Wellmark IA PPO |
$4,029.18
|
|
|
DRAINAGE OF ARM LESION
|
Facility
|
IP
|
$2,068.00
|
|
|
Service Code
|
CPT 23930
|
| Hospital Charge Code |
7982940
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$1,861.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,861.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,861.20
|
| Rate for Payer: Cash Price |
$1,654.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,551.00
|
| Rate for Payer: Medical Associates Commercial |
$1,551.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,447.60
|
| Rate for Payer: United Healthcare Commercial |
$1,861.20
|
|
|
DRAINAGE OF BREAST LESION
|
Facility
|
IP
|
$951.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
7982925
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$665.70 |
| Max. Negotiated Rate |
$855.90 |
| Rate for Payer: Aetna of IA Commercial |
$855.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$855.90
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$713.25
|
| Rate for Payer: Medical Associates Commercial |
$713.25
|
| Rate for Payer: Midlands Choice Commercial |
$665.70
|
| Rate for Payer: United Healthcare Commercial |
$855.90
|
|
|
DRAINAGE OF BREAST LESION
|
Facility
|
OP
|
$951.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
7982925
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.95 |
| Max. Negotiated Rate |
$855.90 |
| Rate for Payer: Aetna of IA Commercial |
$855.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$855.90
|
| Rate for Payer: Aetna of IA Medicare |
$542.07
|
| Rate for Payer: Amerigroup Medicaid |
$548.54
|
| Rate for Payer: Amerigroup Medicare |
$432.23
|
| Rate for Payer: Cash Price |
$760.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$713.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$427.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$543.21
|
| Rate for Payer: Medical Associates Commercial |
$713.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$427.95
|
| Rate for Payer: Midlands Choice Commercial |
$665.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$551.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$492.14
|
| Rate for Payer: United Healthcare Commercial |
$855.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$561.09
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
4866838
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$388.50 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Aetna of IA Commercial |
$499.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$499.50
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$416.25
|
| Rate for Payer: Medical Associates Commercial |
$416.25
|
| Rate for Payer: Midlands Choice Commercial |
$388.50
|
| Rate for Payer: United Healthcare Commercial |
$499.50
|
|
|
DRAINAGE OF EYELID ABSCESS
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
4866838
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.75 |
| Max. Negotiated Rate |
$963.75 |
| Rate for Payer: Aetna of IA Commercial |
$499.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$499.50
|
| Rate for Payer: Aetna of IA Medicare |
$316.35
|
| Rate for Payer: Amerigroup Medicaid |
$320.12
|
| Rate for Payer: Amerigroup Medicare |
$252.25
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Cash Price |
$444.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$416.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$249.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$317.02
|
| Rate for Payer: Medical Associates Commercial |
$416.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$388.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$321.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$287.21
|
| Rate for Payer: United Healthcare Commercial |
$499.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$327.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$874.91
|
| Rate for Payer: Wellmark IA PPO |
$963.75
|
|
|
DRAINAGE OF FINGER ABSCESS
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
4864859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.80 |
| Max. Negotiated Rate |
$534.60 |
| Rate for Payer: Aetna of IA Commercial |
$534.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$534.60
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$445.50
|
| Rate for Payer: Medical Associates Commercial |
$445.50
|
| Rate for Payer: Midlands Choice Commercial |
$415.80
|
| Rate for Payer: United Healthcare Commercial |
$534.60
|
|
|
DRAINAGE OF FINGER ABSCESS
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
4864859
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$267.30 |
| Max. Negotiated Rate |
$534.60 |
| Rate for Payer: Aetna of IA Commercial |
$534.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$534.60
|
| Rate for Payer: Aetna of IA Medicare |
$338.58
|
| Rate for Payer: Amerigroup Medicaid |
$342.62
|
| Rate for Payer: Amerigroup Medicare |
$269.97
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$445.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$267.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$339.29
|
| Rate for Payer: Medical Associates Commercial |
$445.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$267.30
|
| Rate for Payer: Midlands Choice Commercial |
$415.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$344.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$307.40
|
| Rate for Payer: United Healthcare Commercial |
$534.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$350.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$302.74
|
| Rate for Payer: Wellmark IA PPO |
$333.49
|
|
|
DRAINAGE OF FINGER ABSCESS
|
Professional
|
Both
|
$876.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
7982804
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$138.00 |
| Max. Negotiated Rate |
$766.60 |
| Rate for Payer: Amerigroup Medicaid |
$139.35
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Cash Price |
$700.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$138.00
|
| Rate for Payer: Medical Associates Commercial |
$657.00
|
| Rate for Payer: Midlands Choice Commercial |
$613.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$138.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$657.00
|
| Rate for Payer: United Healthcare Commercial |
$452.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$651.60
|
| Rate for Payer: Wellmark IA PPO |
$766.60
|
|
|
DRAINAGE OF FOREARM LESION
|
Facility
|
OP
|
$3,062.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
4864840
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,377.90 |
| Max. Negotiated Rate |
$4,391.56 |
| Rate for Payer: Aetna of IA Commercial |
$2,755.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,755.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,745.34
|
| Rate for Payer: Amerigroup Medicaid |
$1,766.16
|
| Rate for Payer: Amerigroup Medicare |
$1,391.68
|
| Rate for Payer: Cash Price |
$2,449.60
|
| Rate for Payer: Cash Price |
$2,449.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,296.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,377.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,749.01
|
| Rate for Payer: Medical Associates Commercial |
$2,296.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,377.90
|
| Rate for Payer: Midlands Choice Commercial |
$2,143.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,774.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,584.58
|
| Rate for Payer: United Healthcare Commercial |
$2,755.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,806.58
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,986.71
|
| Rate for Payer: Wellmark IA PPO |
$4,391.56
|
|
|
DRAINAGE OF FOREARM LESION
|
Facility
|
IP
|
$3,062.00
|
|
|
Service Code
|
CPT 25028
|
| Hospital Charge Code |
4864840
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,143.40 |
| Max. Negotiated Rate |
$2,755.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,755.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,755.80
|
| Rate for Payer: Cash Price |
$2,449.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,296.50
|
| Rate for Payer: Medical Associates Commercial |
$2,296.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,143.40
|
| Rate for Payer: United Healthcare Commercial |
$2,755.80
|
|
|
DRAINAGE OF GUM LESION
|
Professional
|
Both
|
$931.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
7982772
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$83.91 |
| Max. Negotiated Rate |
$698.25 |
| Rate for Payer: Amerigroup Medicaid |
$84.73
|
| Rate for Payer: Cash Price |
$744.80
|
| Rate for Payer: Cash Price |
$744.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$83.91
|
| Rate for Payer: Medical Associates Commercial |
$698.25
|
| Rate for Payer: Midlands Choice Commercial |
$651.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$84.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$698.25
|
| Rate for Payer: United Healthcare Commercial |
$439.57
|
| Rate for Payer: Wellmark IA HMO WHPI |
$561.40
|
| Rate for Payer: Wellmark IA PPO |
$660.50
|
|
|
DRAINAGE OF GUM LESION
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
4864957
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.00 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna of IA Commercial |
$594.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$594.00
|
| Rate for Payer: Aetna of IA Medicare |
$376.20
|
| Rate for Payer: Amerigroup Medicaid |
$380.69
|
| Rate for Payer: Amerigroup Medicare |
$299.97
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$495.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$297.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$376.99
|
| Rate for Payer: Medical Associates Commercial |
$495.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$297.00
|
| Rate for Payer: Midlands Choice Commercial |
$462.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$382.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$341.55
|
| Rate for Payer: United Healthcare Commercial |
$594.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$389.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$336.78
|
| Rate for Payer: Wellmark IA PPO |
$370.98
|
|
|
DRAINAGE OF GUM LESION
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 41800
|
| Hospital Charge Code |
4864957
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$462.00 |
| Max. Negotiated Rate |
$594.00 |
| Rate for Payer: Aetna of IA Commercial |
$594.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$594.00
|
| Rate for Payer: Cash Price |
$528.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$495.00
|
| Rate for Payer: Medical Associates Commercial |
$495.00
|
| Rate for Payer: Midlands Choice Commercial |
$462.00
|
| Rate for Payer: United Healthcare Commercial |
$594.00
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
4862799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Aetna of IA Commercial |
$891.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$891.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$742.50
|
| Rate for Payer: Medical Associates Commercial |
$742.50
|
| Rate for Payer: Midlands Choice Commercial |
$693.00
|
| Rate for Payer: United Healthcare Commercial |
$891.00
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
4862799
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$2,456.25 |
| Rate for Payer: Aetna of IA Commercial |
$891.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$891.00
|
| Rate for Payer: Aetna of IA Medicare |
$564.30
|
| Rate for Payer: Amerigroup Medicaid |
$571.03
|
| Rate for Payer: Amerigroup Medicare |
$449.96
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$742.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$445.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$565.49
|
| Rate for Payer: Medical Associates Commercial |
$742.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$445.50
|
| Rate for Payer: Midlands Choice Commercial |
$693.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$573.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$512.32
|
| Rate for Payer: United Healthcare Commercial |
$891.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$584.10
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,229.81
|
| Rate for Payer: Wellmark IA PPO |
$2,456.25
|
|
|
DRAINAGE OF HEMATOMA/FLUID
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
7982855
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$87.45 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Amerigroup Medicaid |
$88.31
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.45
|
| Rate for Payer: Medical Associates Commercial |
$405.00
|
| Rate for Payer: Midlands Choice Commercial |
$378.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$87.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$405.00
|
| Rate for Payer: United Healthcare Commercial |
$256.35
|
| Rate for Payer: Wellmark IA HMO WHPI |
$311.20
|
| Rate for Payer: Wellmark IA PPO |
$366.10
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
4864951
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Aetna of IA Commercial |
$586.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.80
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$489.00
|
| Rate for Payer: Medical Associates Commercial |
$489.00
|
| Rate for Payer: Midlands Choice Commercial |
$456.40
|
| Rate for Payer: United Healthcare Commercial |
$586.80
|
|
|
DRAINAGE OF MOUTH LESION
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
4864951
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$3,918.28 |
| Rate for Payer: Aetna of IA Commercial |
$586.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.80
|
| Rate for Payer: Aetna of IA Medicare |
$371.64
|
| Rate for Payer: Amerigroup Medicaid |
$376.07
|
| Rate for Payer: Amerigroup Medicare |
$296.33
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$489.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$293.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$372.42
|
| Rate for Payer: Medical Associates Commercial |
$489.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$293.40
|
| Rate for Payer: Midlands Choice Commercial |
$456.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$377.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$337.41
|
| Rate for Payer: United Healthcare Commercial |
$586.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$384.68
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,557.05
|
| Rate for Payer: Wellmark IA PPO |
$3,918.28
|
|
|
DRAINAGE OF MOUTH LESION
|
Professional
|
Both
|
$718.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
7982774
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$84.29 |
| Max. Negotiated Rate |
$538.50 |
| Rate for Payer: Amerigroup Medicaid |
$85.12
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Cash Price |
$574.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$84.29
|
| Rate for Payer: Medical Associates Commercial |
$538.50
|
| Rate for Payer: Midlands Choice Commercial |
$502.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$84.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$538.50
|
| Rate for Payer: United Healthcare Commercial |
$315.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$389.70
|
| Rate for Payer: Wellmark IA PPO |
$458.40
|
|
