|
4.00X54MM GL ANKLE SYNDESMOTIC SCREW LOW PROFILE
|
Facility
OP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8780889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.90 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Aetna of IA Medicare |
$287.28
|
| Rate for Payer: Amerigroup Medicaid |
$254.37
|
| Rate for Payer: Amerigroup Medicare |
$254.52
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$252.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$251.90
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$252.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$255.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$378.00
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$297.36
|
|
|
4.00X54MM GL ANKLE SYNDESMOTIC SCREW LOW PROFILE
|
Facility
IP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8780889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
|
|
4.0MMX46 GL ANKLE SYNDESMOTIC SCREW LOW PROFILE
|
Facility
IP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
|
|
4.0MMX46 GL ANKLE SYNDESMOTIC SCREW LOW PROFILE
|
Facility
OP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758438
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.90 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Aetna of IA Medicare |
$287.28
|
| Rate for Payer: Amerigroup Medicaid |
$254.37
|
| Rate for Payer: Amerigroup Medicare |
$254.52
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$252.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$251.90
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$252.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$255.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$378.00
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$297.36
|
|
|
4.0MMX46MM TIGER CANNULATED SCREW
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8749761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
4.0MMX46MM TIGER CANNULATED SCREW
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8749761
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
4.0MMX50MM GL ANKLE SYNDESMOTIC SCREW LOW PROFILE
|
Facility
IP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
|
|
4.0MMX50MM GL ANKLE SYNDESMOTIC SCREW LOW PROFILE
|
Facility
OP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.90 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Aetna of IA Medicare |
$287.28
|
| Rate for Payer: Amerigroup Medicaid |
$254.37
|
| Rate for Payer: Amerigroup Medicare |
$254.52
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$252.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$251.90
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$252.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$255.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$378.00
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$297.36
|
|
|
4.0MMX56 GL ANKLE SYNDESMOTIC SCREW LOW PROFILE
|
Facility
OP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.90 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Aetna of IA Medicare |
$287.28
|
| Rate for Payer: Amerigroup Medicaid |
$254.37
|
| Rate for Payer: Amerigroup Medicare |
$254.52
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$252.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$251.90
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$252.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$255.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$378.00
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$297.36
|
|
|
4.0MMX56 GL ANKLE SYNDESMOTIC SCREW LOW PROFILE
|
Facility
IP
|
$504.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8760641
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of IA Commercial |
$453.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$453.60
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.00
|
| Rate for Payer: Medical Associates Commercial |
$378.00
|
| Rate for Payer: Midlands Choice Commercial |
$352.80
|
| Rate for Payer: United Healthcare Commercial |
$453.60
|
|
|
43235 EGD DX BRUSHWASH (NO BX)
|
Professional
|
$849.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
8069022
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.59 |
| Max. Negotiated Rate |
$594.30 |
| Rate for Payer: Aetna of IA Medicare |
$110.59
|
| Rate for Payer: Amerigroup Medicaid |
$114.35
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Cash Price |
$679.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$112.80
|
| Rate for Payer: Medical Associates Commercial |
$210.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.59
|
| Rate for Payer: Midlands Choice Commercial |
$594.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.88
|
| Rate for Payer: Wellmark IA HMO |
$229.00
|
| Rate for Payer: Wellmark IA PPO |
$269.00
|
|
|
43239 EGD W/ BX (COLD FORCEPS)
|
Professional
|
$1,135.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
8069041
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$124.90 |
| Max. Negotiated Rate |
$794.50 |
| Rate for Payer: Aetna of IA Medicare |
$124.90
|
| Rate for Payer: Amerigroup Medicaid |
$129.15
|
| Rate for Payer: Cash Price |
$908.00
|
| Rate for Payer: Cash Price |
$908.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$149.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$127.40
|
| Rate for Payer: Medical Associates Commercial |
$237.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$124.90
|
| Rate for Payer: Midlands Choice Commercial |
$794.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$187.35
|
| Rate for Payer: Wellmark IA HMO |
$259.00
|
| Rate for Payer: Wellmark IA PPO |
$304.00
|
|
|
43241 EGD W/ INSERTION OF INTRALUMINAL TUB OR CATHETER
|
Professional
|
$489.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
8069121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$128.03 |
| Max. Negotiated Rate |
$342.30 |
| Rate for Payer: Aetna of IA Medicare |
$128.03
|
| Rate for Payer: Amerigroup Medicaid |
$132.38
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Cash Price |
$391.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$153.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$130.59
|
| Rate for Payer: Medical Associates Commercial |
$243.26
|
| Rate for Payer: Medical Associates Managed Medicare |
$128.03
|
| Rate for Payer: Midlands Choice Commercial |
$342.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$192.04
|
| Rate for Payer: Wellmark IA HMO |
$265.00
|
| Rate for Payer: Wellmark IA PPO |
$311.00
|
|
|
43245 EGD W/ DILATION OF GASTRIC/DUODENAL STRICTURE W/ BALLO
|
Professional
|
$1,828.00
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
8069065
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$157.36 |
| Max. Negotiated Rate |
$1,279.60 |
| Rate for Payer: Aetna of IA Medicare |
$157.36
|
| Rate for Payer: Amerigroup Medicaid |
$162.71
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Cash Price |
$1,462.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$188.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$160.51
|
| Rate for Payer: Medical Associates Commercial |
$298.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.36
|
| Rate for Payer: Midlands Choice Commercial |
$1,279.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.04
|
| Rate for Payer: Wellmark IA HMO |
$329.00
|
| Rate for Payer: Wellmark IA PPO |
$386.00
|
|
|
43247 EGD WITH REMOVAL OF FOREIGN BODY
|
Professional
|
$1,159.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
8069093
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$158.94 |
| Max. Negotiated Rate |
$811.30 |
| Rate for Payer: Aetna of IA Medicare |
$158.94
|
| Rate for Payer: Amerigroup Medicaid |
$164.34
|
| Rate for Payer: Cash Price |
$927.20
|
| Rate for Payer: Cash Price |
$927.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$190.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$162.12
|
| Rate for Payer: Medical Associates Commercial |
$301.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$158.94
|
| Rate for Payer: Midlands Choice Commercial |
$811.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$238.41
|
| Rate for Payer: Wellmark IA HMO |
$331.00
|
| Rate for Payer: Wellmark IA PPO |
$388.00
|
|
|
43248 EGD W/ DILATION INSERT GUIDEWIRE W/ PASSAGE OF DILATO
|
Professional
|
$1,161.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
8069064
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$149.70 |
| Max. Negotiated Rate |
$812.70 |
| Rate for Payer: Aetna of IA Medicare |
$149.70
|
| Rate for Payer: Amerigroup Medicaid |
$154.79
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Cash Price |
$928.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$152.69
|
| Rate for Payer: Medical Associates Commercial |
$284.43
|
| Rate for Payer: Medical Associates Managed Medicare |
$149.70
|
| Rate for Payer: Midlands Choice Commercial |
$812.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$224.55
|
| Rate for Payer: Wellmark IA HMO |
$310.00
|
| Rate for Payer: Wellmark IA PPO |
$364.00
|
|
|
43249 ESOPH EGD DILATION <30 MM
|
Professional
|
$3,362.00
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
8051990
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$138.25 |
| Max. Negotiated Rate |
$2,353.40 |
| Rate for Payer: Aetna of IA Medicare |
$138.25
|
| Rate for Payer: Amerigroup Medicaid |
$142.95
|
| Rate for Payer: Cash Price |
$2,689.60
|
| Rate for Payer: Cash Price |
$2,689.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$141.02
|
| Rate for Payer: Medical Associates Commercial |
$262.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$138.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,353.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$207.38
|
| Rate for Payer: Wellmark IA HMO |
$287.00
|
| Rate for Payer: Wellmark IA PPO |
$337.00
|
|
|
43250 EGD W/ POLYPS REMOVAL VIA HOT FORCEPS
|
Professional
|
$1,316.00
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
8069034
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$152.41 |
| Max. Negotiated Rate |
$921.20 |
| Rate for Payer: Aetna of IA Medicare |
$152.41
|
| Rate for Payer: Amerigroup Medicaid |
$157.59
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$182.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$155.46
|
| Rate for Payer: Medical Associates Commercial |
$289.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$152.41
|
| Rate for Payer: Midlands Choice Commercial |
$921.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$228.62
|
| Rate for Payer: Wellmark IA HMO |
$319.00
|
| Rate for Payer: Wellmark IA PPO |
$374.00
|
|
|
43251 EGD W/ SNARE POLYPECTOMY (HOT OR COLD SNARE)
|
Professional
|
$1,458.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
8069171
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$176.41 |
| Max. Negotiated Rate |
$1,020.60 |
| Rate for Payer: Aetna of IA Medicare |
$176.41
|
| Rate for Payer: Amerigroup Medicaid |
$182.41
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Cash Price |
$1,166.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$211.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.94
|
| Rate for Payer: Medical Associates Commercial |
$335.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$176.41
|
| Rate for Payer: Midlands Choice Commercial |
$1,020.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$264.62
|
| Rate for Payer: Wellmark IA HMO |
$366.00
|
| Rate for Payer: Wellmark IA PPO |
$430.00
|
|
|
43255 EGD with control of bleeding any method
|
Professional
|
$2,189.00
|
|
|
Service Code
|
CPT 43255
|
| Hospital Charge Code |
8799174
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$1,532.30 |
| Rate for Payer: Aetna of IA Medicare |
$180.40
|
| Rate for Payer: Amerigroup Medicaid |
$186.53
|
| Rate for Payer: Cash Price |
$1,751.20
|
| Rate for Payer: Cash Price |
$1,751.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$184.01
|
| Rate for Payer: Medical Associates Commercial |
$342.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$180.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,532.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$270.60
|
| Rate for Payer: Wellmark IA HMO |
$374.00
|
| Rate for Payer: Wellmark IA PPO |
$439.00
|
|
|
43760 GASTROSTOMY CHANGE/REPOSITION
|
Professional
|
$1,621.00
|
|
|
Service Code
|
CPT 43760
|
| Hospital Charge Code |
8069071
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$1,134.70 |
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Cash Price |
$1,296.80
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,134.70
|
| Rate for Payer: Wellmark IA HMO |
$81.00
|
| Rate for Payer: Wellmark IA PPO |
$99.00
|
|
|
43830 GASTROSTOMY PEG
|
Professional
|
$2,358.00
|
|
|
Service Code
|
CPT 43830
|
| Hospital Charge Code |
8069029
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$624.53 |
| Max. Negotiated Rate |
$1,650.60 |
| Rate for Payer: Aetna of IA Medicare |
$624.53
|
| Rate for Payer: Amerigroup Medicaid |
$645.76
|
| Rate for Payer: Cash Price |
$1,886.40
|
| Rate for Payer: Cash Price |
$1,886.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$749.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$637.02
|
| Rate for Payer: Medical Associates Commercial |
$1,186.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$624.53
|
| Rate for Payer: Midlands Choice Commercial |
$1,650.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$936.80
|
| Rate for Payer: Wellmark IA HMO |
$1,343.00
|
| Rate for Payer: Wellmark IA PPO |
$1,576.00
|
|
|
44005 ENTEROLYSIS LYSIS ADHESNS OPEN
|
Professional
|
$3,701.00
|
|
|
Service Code
|
CPT 44005
|
| Hospital Charge Code |
8069047
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$963.58 |
| Max. Negotiated Rate |
$2,590.70 |
| Rate for Payer: Aetna of IA Medicare |
$963.58
|
| Rate for Payer: Amerigroup Medicaid |
$996.34
|
| Rate for Payer: Cash Price |
$2,960.80
|
| Rate for Payer: Cash Price |
$2,960.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,156.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$982.85
|
| Rate for Payer: Medical Associates Commercial |
$1,830.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$963.58
|
| Rate for Payer: Midlands Choice Commercial |
$2,590.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,445.37
|
| Rate for Payer: Wellmark IA HMO |
$2,073.00
|
| Rate for Payer: Wellmark IA PPO |
$2,433.00
|
|
|
44110 Excision of 1+ lesions of small/large intestine; single enterotomy
|
Professional
|
$2,862.00
|
|
|
Service Code
|
CPT 44110
|
| Hospital Charge Code |
8799175
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$757.69 |
| Max. Negotiated Rate |
$2,003.40 |
| Rate for Payer: Aetna of IA Medicare |
$757.69
|
| Rate for Payer: Amerigroup Medicaid |
$783.45
|
| Rate for Payer: Cash Price |
$2,289.60
|
| Rate for Payer: Cash Price |
$2,289.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$909.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$772.84
|
| Rate for Payer: Medical Associates Commercial |
$1,439.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$757.69
|
| Rate for Payer: Midlands Choice Commercial |
$2,003.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,136.54
|
| Rate for Payer: Wellmark IA HMO |
$1,610.00
|
| Rate for Payer: Wellmark IA PPO |
$1,890.00
|
|
|
44120 RESECT SM INTESTINE W/ANASTOMOSIS ILCOST
|
Professional
|
$4,136.00
|
|
|
Service Code
|
CPT 44120
|
| Hospital Charge Code |
8069011
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,077.63 |
| Max. Negotiated Rate |
$2,895.20 |
| Rate for Payer: Aetna of IA Medicare |
$1,077.63
|
| Rate for Payer: Amerigroup Medicaid |
$1,114.27
|
| Rate for Payer: Cash Price |
$3,308.80
|
| Rate for Payer: Cash Price |
$3,308.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,293.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,099.18
|
| Rate for Payer: Medical Associates Commercial |
$2,047.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,077.63
|
| Rate for Payer: Midlands Choice Commercial |
$2,895.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,616.44
|
| Rate for Payer: Wellmark IA HMO |
$2,318.00
|
| Rate for Payer: Wellmark IA PPO |
$2,721.00
|
|
