|
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
|
$1,663.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
7982930
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$748.35 |
| Max. Negotiated Rate |
$3,151.34 |
| Rate for Payer: Aetna of IA Commercial |
$1,496.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,496.70
|
| Rate for Payer: Aetna of IA Medicare |
$947.91
|
| Rate for Payer: Amerigroup Medicaid |
$959.22
|
| Rate for Payer: Amerigroup Medicare |
$755.83
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,247.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$748.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$949.91
|
| Rate for Payer: Medical Associates Commercial |
$1,247.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$748.35
|
| Rate for Payer: Midlands Choice Commercial |
$1,164.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$963.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$860.60
|
| Rate for Payer: United Healthcare Commercial |
$1,496.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$981.17
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,860.82
|
| Rate for Payer: Wellmark IA PPO |
$3,151.34
|
|
|
DRAINAGE OF PILONIDAL CYST
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
4862793
|
|
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 PILONIDAL CYST
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
4862793
|
|
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 |
$302.74
|
| Rate for Payer: Wellmark IA PPO |
$333.49
|
|
|
DRAINAGE OF PILONIDAL CYST
|
Facility
|
OP
|
$1,448.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
4862795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$651.60 |
| Max. Negotiated Rate |
$2,456.25 |
| Rate for Payer: Aetna of IA Commercial |
$1,303.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,303.20
|
| Rate for Payer: Aetna of IA Medicare |
$825.36
|
| Rate for Payer: Amerigroup Medicaid |
$835.21
|
| Rate for Payer: Amerigroup Medicare |
$658.12
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,086.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$651.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$827.10
|
| Rate for Payer: Medical Associates Commercial |
$1,086.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$651.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,013.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$839.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$749.34
|
| Rate for Payer: United Healthcare Commercial |
$1,303.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$854.32
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,229.81
|
| Rate for Payer: Wellmark IA PPO |
$2,456.25
|
|
|
DRAINAGE OF PILONIDAL CYST
|
Facility
|
IP
|
$1,448.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
4862795
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,013.60 |
| Max. Negotiated Rate |
$1,303.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,303.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,303.20
|
| Rate for Payer: Cash Price |
$1,158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,086.00
|
| Rate for Payer: Medical Associates Commercial |
$1,086.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,013.60
|
| Rate for Payer: United Healthcare Commercial |
$1,303.20
|
|
|
DRAINAGE OF PILONIDAL CYST
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
7982858
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$84.97 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Amerigroup Medicaid |
$85.80
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Cash Price |
$340.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$84.97
|
| Rate for Payer: Medical Associates Commercial |
$318.75
|
| Rate for Payer: Midlands Choice Commercial |
$297.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$85.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$318.75
|
| Rate for Payer: United Healthcare Commercial |
$314.98
|
| Rate for Payer: Wellmark IA HMO WHPI |
$458.20
|
| Rate for Payer: Wellmark IA PPO |
$539.10
|
|
|
DRAINAGE OF PILONIDAL CYST
|
Professional
|
Both
|
$890.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
7982857
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$156.63 |
| Max. Negotiated Rate |
$740.00 |
| Rate for Payer: Amerigroup Medicaid |
$158.17
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Cash Price |
$712.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$156.63
|
| Rate for Payer: Medical Associates Commercial |
$667.50
|
| Rate for Payer: Midlands Choice Commercial |
$623.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$157.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$667.50
|
| Rate for Payer: United Healthcare Commercial |
$456.62
|
| Rate for Payer: Wellmark IA HMO WHPI |
$629.00
|
| Rate for Payer: Wellmark IA PPO |
$740.00
|
|
|
DRAINAGE OF RECTAL ABSCESS
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
7982941
|
|
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
|
|
|
DRAINAGE OF RECTAL ABSCESS
|
Professional
|
Both
|
$917.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
7982863
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$167.88 |
| Max. Negotiated Rate |
$714.80 |
| Rate for Payer: Amerigroup Medicaid |
$169.53
|
| Rate for Payer: Cash Price |
$733.60
|
| Rate for Payer: Cash Price |
$733.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$167.88
|
| Rate for Payer: Medical Associates Commercial |
$687.75
|
| Rate for Payer: Midlands Choice Commercial |
$641.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$168.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$687.75
|
| Rate for Payer: United Healthcare Commercial |
$437.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$607.60
|
| Rate for Payer: Wellmark IA PPO |
$714.80
|
|
|
DRAINAGE OF RECTAL ABSCESS
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT 45005
|
| Hospital Charge Code |
7982941
|
|
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
|
|
|
DRAINAGE OF SKIN ABSCESS
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
4860788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Aetna of IA Commercial |
$356.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$356.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$297.00
|
| Rate for Payer: Medical Associates Commercial |
$297.00
|
| Rate for Payer: Midlands Choice Commercial |
$277.20
|
| Rate for Payer: United Healthcare Commercial |
$356.40
|
|
|
DRAINAGE OF SKIN ABSCESS
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
4862791
|
|
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 |
$302.74
|
| Rate for Payer: Wellmark IA PPO |
$333.49
|
|
|
DRAINAGE OF SKIN ABSCESS
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
4860788
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.20 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Aetna of IA Commercial |
$356.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$356.40
|
| Rate for Payer: Aetna of IA Medicare |
$225.72
|
| Rate for Payer: Amerigroup Medicaid |
$228.41
|
| Rate for Payer: Amerigroup Medicare |
$179.98
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$297.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$178.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$226.20
|
| Rate for Payer: Medical Associates Commercial |
$297.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$178.20
|
| Rate for Payer: Midlands Choice Commercial |
$277.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$229.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$204.93
|
| Rate for Payer: United Healthcare Commercial |
$356.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$233.64
|
| Rate for Payer: Wellmark IA HMO WHPI |
$302.74
|
| Rate for Payer: Wellmark IA PPO |
$333.49
|
|
|
DRAINAGE OF SKIN ABSCESS
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
7982859
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$132.61 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Amerigroup Medicaid |
$133.91
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Cash Price |
$446.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$132.61
|
| Rate for Payer: Medical Associates Commercial |
$418.50
|
| Rate for Payer: Midlands Choice Commercial |
$390.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$133.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$418.50
|
| Rate for Payer: United Healthcare Commercial |
$316.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$393.20
|
| Rate for Payer: Wellmark IA PPO |
$462.60
|
|
|
DRAINAGE OF SKIN ABSCESS
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
4862791
|
|
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 TONSIL ABSCESS
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
4864958
|
|
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 TONSIL ABSCESS
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
4864958
|
|
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
|
|
|
DRAIN BLOOD FROM UNDER NAIL
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
4863315
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
DRAIN BLOOD FROM UNDER NAIL
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
4863315
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.05 |
| Max. Negotiated Rate |
$487.34 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$74.41
|
| Rate for Payer: Amerigroup Medicare |
$58.63
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.68
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.05
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$66.76
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
| Rate for Payer: Wellmark IA HMO WHPI |
$442.42
|
| Rate for Payer: Wellmark IA PPO |
$487.34
|
|
|
DRAIN BLOOD FROM UNDER NAIL
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
7982848
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$31.34 |
| Max. Negotiated Rate |
$124.40 |
| Rate for Payer: Amerigroup Medicaid |
$31.65
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.34
|
| Rate for Payer: Medical Associates Commercial |
$122.25
|
| Rate for Payer: Midlands Choice Commercial |
$114.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$122.25
|
| Rate for Payer: United Healthcare Commercial |
$80.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$105.70
|
| Rate for Payer: Wellmark IA PPO |
$124.40
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
OP
|
$3,709.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
4862810
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,669.05 |
| Max. Negotiated Rate |
$3,338.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,338.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,338.10
|
| Rate for Payer: Aetna of IA Medicare |
$2,114.13
|
| Rate for Payer: Amerigroup Medicaid |
$2,139.35
|
| Rate for Payer: Amerigroup Medicare |
$1,685.74
|
| Rate for Payer: Cash Price |
$2,967.20
|
| Rate for Payer: Cash Price |
$2,967.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,781.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,669.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,118.58
|
| Rate for Payer: Medical Associates Commercial |
$2,781.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,669.05
|
| Rate for Payer: Midlands Choice Commercial |
$2,596.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,149.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,919.41
|
| Rate for Payer: United Healthcare Commercial |
$3,338.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,188.31
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,669.39
|
| Rate for Payer: Wellmark IA PPO |
$2,940.47
|
|
|
DRAIN BL W/CATH INSERTION
|
Professional
|
Both
|
$756.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
7982768
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$275.09 |
| Max. Negotiated Rate |
$567.00 |
| Rate for Payer: Amerigroup Medicaid |
$277.79
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$275.09
|
| Rate for Payer: Medical Associates Commercial |
$567.00
|
| Rate for Payer: Midlands Choice Commercial |
$529.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$276.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$567.00
|
| Rate for Payer: United Healthcare Commercial |
$361.22
|
| Rate for Payer: Wellmark IA HMO WHPI |
$448.50
|
| Rate for Payer: Wellmark IA PPO |
$527.70
|
|
|
DRAIN BL W/CATH INSERTION
|
Facility
|
IP
|
$3,709.00
|
|
|
Service Code
|
CPT 51102
|
| Hospital Charge Code |
4862810
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,596.30 |
| Max. Negotiated Rate |
$3,338.10 |
| Rate for Payer: Aetna of IA Commercial |
$3,338.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,338.10
|
| Rate for Payer: Cash Price |
$2,967.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,781.75
|
| Rate for Payer: Medical Associates Commercial |
$2,781.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,596.30
|
| Rate for Payer: United Healthcare Commercial |
$3,338.10
|
|
|
DRAIN CEREBRO SPINAL FLUID
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
7982915
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,679.15 |
| Rate for Payer: Aetna of IA Commercial |
$1,008.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,008.00
|
| Rate for Payer: Aetna of IA Medicare |
$638.40
|
| Rate for Payer: Amerigroup Medicaid |
$646.02
|
| Rate for Payer: Amerigroup Medicare |
$509.04
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$840.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$504.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$639.74
|
| Rate for Payer: Medical Associates Commercial |
$840.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$504.00
|
| Rate for Payer: Midlands Choice Commercial |
$784.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$649.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$579.60
|
| Rate for Payer: United Healthcare Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$660.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,524.35
|
| Rate for Payer: Wellmark IA PPO |
$1,679.15
|
|
