|
ESTRIOL UNCONJUGATED
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
8037490
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Aetna of IA Medicare |
$83.22
|
| Rate for Payer: Amerigroup Medicaid |
$73.69
|
| Rate for Payer: Amerigroup Medicare |
$73.73
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.97
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.00
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.10
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$74.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$109.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$109.50
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.14
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
ESTRIOL UNCONJUGATED
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
8037490
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
|
|
Estrogens Fractionated (E1 and E2) DMCL
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
8037842
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of IA Commercial |
$171.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.00
|
| Rate for Payer: Aetna of IA Medicare |
$108.30
|
| Rate for Payer: Amerigroup Medicaid |
$95.89
|
| Rate for Payer: Amerigroup Medicare |
$95.95
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$142.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$95.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.96
|
| Rate for Payer: Medical Associates Commercial |
$142.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.00
|
| Rate for Payer: Midlands Choice Commercial |
$133.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$96.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$96.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$142.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$142.50
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$112.10
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Estrogens Fractionated (E1 and E2) DMCL
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
8037842
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna of IA Commercial |
$171.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$171.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$142.50
|
| Rate for Payer: Medical Associates Commercial |
$142.50
|
| Rate for Payer: Midlands Choice Commercial |
$133.00
|
| Rate for Payer: United Healthcare Commercial |
$171.00
|
|
|
ETHICON ENDO GIA GUN
|
Facility
|
IP
|
$480.00
|
|
| Hospital Charge Code |
8026300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna of IA Commercial |
$432.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$432.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$360.00
|
| Rate for Payer: Medical Associates Commercial |
$360.00
|
| Rate for Payer: Midlands Choice Commercial |
$336.00
|
| Rate for Payer: United Healthcare Commercial |
$432.00
|
|
|
ETHICON ENDO GIA GUN
|
Facility
|
OP
|
$480.00
|
|
| Hospital Charge Code |
8026300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.90 |
| Max. Negotiated Rate |
$432.00 |
| Rate for Payer: Aetna of IA Commercial |
$432.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$432.00
|
| Rate for Payer: Aetna of IA Medicare |
$273.60
|
| Rate for Payer: Amerigroup Medicaid |
$242.26
|
| Rate for Payer: Amerigroup Medicare |
$242.40
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$360.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$240.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$239.90
|
| Rate for Payer: Medical Associates Commercial |
$360.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$240.00
|
| Rate for Payer: Midlands Choice Commercial |
$336.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$243.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$243.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$360.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$360.00
|
| Rate for Payer: United Healthcare Commercial |
$432.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$283.20
|
|
|
etomidate 2 mg/mL IV 10 ml SDV [VDMC]
|
Facility
|
OP
|
$28.02
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10387670
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Aetna of IA Commercial |
$25.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.22
|
| Rate for Payer: Aetna of IA Medicare |
$15.97
|
| Rate for Payer: Amerigroup Medicaid |
$14.14
|
| Rate for Payer: Amerigroup Medicare |
$14.15
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.02
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.01
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.00
|
| Rate for Payer: Medical Associates Commercial |
$21.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.01
|
| Rate for Payer: Midlands Choice Commercial |
$19.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.22
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$14.21
|
| Rate for Payer: Oscar Health of IA Commercial |
$21.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.02
|
| Rate for Payer: United Healthcare Commercial |
$25.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.53
|
|
|
etomidate 2 mg/mL IV 10 ml SDV [VDMC]
|
Facility
|
IP
|
$28.02
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10387670
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.61 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Aetna of IA Commercial |
$25.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.22
|
| Rate for Payer: Cash Price |
$22.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.02
|
| Rate for Payer: Medical Associates Commercial |
$21.02
|
| Rate for Payer: Midlands Choice Commercial |
$19.61
|
| Rate for Payer: United Healthcare Commercial |
$25.22
|
|
|
etonogestrel 68 mg Imp[VDMC]
|
Facility
|
IP
|
$2,063.12
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
12485011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,444.18 |
| Max. Negotiated Rate |
$1,856.81 |
| Rate for Payer: Aetna of IA Commercial |
$1,856.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,856.81
|
| Rate for Payer: Cash Price |
$1,650.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,547.34
|
| Rate for Payer: Medical Associates Commercial |
$1,547.34
|
| Rate for Payer: Midlands Choice Commercial |
$1,444.18
|
| Rate for Payer: United Healthcare Commercial |
$1,856.81
|
|
|
etonogestrel 68 mg Imp[VDMC]
|
Facility
|
OP
|
$2,063.12
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
12485011
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,031.15 |
| Max. Negotiated Rate |
$1,856.81 |
| Rate for Payer: Aetna of IA Commercial |
$1,856.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,856.81
|
| Rate for Payer: Aetna of IA Medicare |
$1,175.98
|
| Rate for Payer: Amerigroup Medicaid |
$1,041.26
|
| Rate for Payer: Amerigroup Medicare |
$1,041.88
|
| Rate for Payer: Cash Price |
$1,650.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,547.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,031.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,031.15
|
| Rate for Payer: Medical Associates Commercial |
$1,547.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,031.56
|
| Rate for Payer: Midlands Choice Commercial |
$1,444.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,047.03
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,046.41
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,547.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,547.34
|
| Rate for Payer: United Healthcare Commercial |
$1,856.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,217.24
|
|
|
etoposide 20 mg/mL 5ml MDV [VDMC]
|
Facility
|
OP
|
$84.68
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
20711704
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.32 |
| Max. Negotiated Rate |
$76.21 |
| Rate for Payer: Aetna of IA Commercial |
$76.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.21
|
| Rate for Payer: Aetna of IA Medicare |
$48.27
|
| Rate for Payer: Amerigroup Medicaid |
$42.74
|
| Rate for Payer: Amerigroup Medicare |
$42.76
|
| Rate for Payer: Cash Price |
$67.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.51
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.32
|
| Rate for Payer: Medical Associates Commercial |
$63.51
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.34
|
| Rate for Payer: Midlands Choice Commercial |
$59.28
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.98
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$42.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$63.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.51
|
| Rate for Payer: United Healthcare Commercial |
$76.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$49.96
|
|
|
etoposide 20 mg/mL 5ml MDV [VDMC]
|
Facility
|
IP
|
$84.68
|
|
|
Service Code
|
HCPCS J9181
|
| Hospital Charge Code |
20711704
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$76.21 |
| Rate for Payer: Aetna of IA Commercial |
$76.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.21
|
| Rate for Payer: Cash Price |
$67.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.51
|
| Rate for Payer: Medical Associates Commercial |
$63.51
|
| Rate for Payer: Midlands Choice Commercial |
$59.28
|
| Rate for Payer: United Healthcare Commercial |
$76.21
|
|
|
Everolimus Level DMCL
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
8820559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of IA Commercial |
$216.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$216.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$180.00
|
| Rate for Payer: Medical Associates Commercial |
$180.00
|
| Rate for Payer: Midlands Choice Commercial |
$168.00
|
| Rate for Payer: United Healthcare Commercial |
$216.00
|
|
|
Everolimus Level DMCL
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 80169
|
| Hospital Charge Code |
8820559
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna of IA Commercial |
$216.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$216.00
|
| Rate for Payer: Aetna of IA Medicare |
$136.80
|
| Rate for Payer: Amerigroup Medicaid |
$121.13
|
| Rate for Payer: Amerigroup Medicare |
$121.20
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$180.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$120.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$119.95
|
| Rate for Payer: Medical Associates Commercial |
$180.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$120.00
|
| Rate for Payer: Midlands Choice Commercial |
$168.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$121.80
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$121.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$180.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$180.00
|
| Rate for Payer: United Healthcare Commercial |
$216.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$141.60
|
| Rate for Payer: Wellmark IA HMO |
$49.60
|
| Rate for Payer: Wellmark IA PPO |
$54.56
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
IP
|
$1,014.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
4862821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$709.80 |
| Max. Negotiated Rate |
$912.60 |
| Rate for Payer: Aetna of IA Commercial |
$912.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$912.60
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$760.50
|
| Rate for Payer: Medical Associates Commercial |
$760.50
|
| Rate for Payer: Midlands Choice Commercial |
$709.80
|
| Rate for Payer: United Healthcare Commercial |
$912.60
|
|
|
EXC H-F-NK-SP B9+MARG 1.1-2
|
Facility
|
OP
|
$1,014.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
4862821
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$506.80 |
| Max. Negotiated Rate |
$1,451.30 |
| Rate for Payer: Aetna of IA Commercial |
$912.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$912.60
|
| Rate for Payer: Aetna of IA Medicare |
$577.98
|
| Rate for Payer: Amerigroup Medicaid |
$511.77
|
| Rate for Payer: Amerigroup Medicare |
$512.07
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Cash Price |
$811.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$760.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$507.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$506.80
|
| Rate for Payer: Medical Associates Commercial |
$760.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$507.00
|
| Rate for Payer: Midlands Choice Commercial |
$709.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$514.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$514.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$760.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$760.50
|
| Rate for Payer: United Healthcare Commercial |
$912.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$598.26
|
| Rate for Payer: Wellmark IA HMO |
$1,319.36
|
| Rate for Payer: Wellmark IA PPO |
$1,451.30
|
|
|
EXCISE VAGINAL CYST OR TUMOR
|
Professional
|
Both
|
$637.00
|
|
|
Service Code
|
CPT 57135
|
| Hospital Charge Code |
8069120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$171.23 |
| Max. Negotiated Rate |
$445.90 |
| Rate for Payer: Aetna of IA Medicare |
$171.23
|
| Rate for Payer: Amerigroup Medicaid |
$177.05
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Cash Price |
$509.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$205.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$174.65
|
| Rate for Payer: Medical Associates Commercial |
$325.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$171.23
|
| Rate for Payer: Midlands Choice Commercial |
$445.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$296.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$256.84
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
|
Facility
|
OP
|
$1,451.30
|
|
|
Service Code
|
CPT 11420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,319.36 |
| Max. Negotiated Rate |
$1,451.30 |
| Rate for Payer: Wellmark IA HMO |
$1,319.36
|
| Rate for Payer: Wellmark IA PPO |
$1,451.30
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm
|
Facility
|
OP
|
$1,451.30
|
|
|
Service Code
|
CPT 11422
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,319.36 |
| Max. Negotiated Rate |
$1,451.30 |
| Rate for Payer: Wellmark IA HMO |
$1,319.36
|
| Rate for Payer: Wellmark IA PPO |
$1,451.30
|
|
|
Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm
|
Facility
|
OP
|
$3,847.84
|
|
|
Service Code
|
CPT 11406
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,498.04 |
| Max. Negotiated Rate |
$3,847.84 |
| Rate for Payer: Wellmark IA HMO |
$3,498.04
|
| Rate for Payer: Wellmark IA PPO |
$3,847.84
|
|
|
Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), each
|
Facility
|
OP
|
$4,658.74
|
|
|
Service Code
|
CPT 28092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,235.22 |
| Max. Negotiated Rate |
$4,658.74 |
| Rate for Payer: Wellmark IA HMO |
$4,235.22
|
| Rate for Payer: Wellmark IA PPO |
$4,658.74
|
|
|
EXCISION OF NAIL FOLD TOE
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
7982845
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$85.69 |
| Max. Negotiated Rate |
$387.10 |
| Rate for Payer: Aetna of IA Medicare |
$85.69
|
| Rate for Payer: Amerigroup Medicaid |
$88.60
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Cash Price |
$442.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.40
|
| Rate for Payer: Medical Associates Commercial |
$154.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.69
|
| Rate for Payer: Midlands Choice Commercial |
$387.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$128.54
|
|
|
EXCISION OF TONGUE LESION
|
Facility
|
IP
|
$1,663.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
7982949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,164.10 |
| Max. Negotiated Rate |
$1,496.70 |
| 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: Cash Price |
$1,330.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,247.25
|
| Rate for Payer: Medical Associates Commercial |
$1,247.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,164.10
|
| Rate for Payer: United Healthcare Commercial |
$1,496.70
|
|
|
EXCISION OF TONGUE LESION
|
Facility
|
OP
|
$1,663.00
|
|
|
Service Code
|
CPT 41110
|
| Hospital Charge Code |
7982949
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$831.17 |
| Max. Negotiated Rate |
$3,851.25 |
| 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 |
$839.32
|
| Rate for Payer: Amerigroup Medicare |
$839.82
|
| 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 |
$831.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$831.17
|
| Rate for Payer: Medical Associates Commercial |
$1,247.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$831.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,164.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$843.97
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$843.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,247.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,247.25
|
| Rate for Payer: United Healthcare Commercial |
$1,496.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$981.17
|
| Rate for Payer: Wellmark IA HMO |
$3,501.14
|
| Rate for Payer: Wellmark IA PPO |
$3,851.25
|
|
|
Excision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm or greater
|
Facility
|
OP
|
$6,163.92
|
|
|
Service Code
|
CPT 27632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,603.56 |
| Max. Negotiated Rate |
$6,163.92 |
| Rate for Payer: Wellmark IA HMO |
$5,603.56
|
| Rate for Payer: Wellmark IA PPO |
$6,163.92
|
|
