|
45382 Colonoscopy w control of bleeding any method
|
Professional
|
$2,360.00
|
|
|
Service Code
|
CPT 45382
|
| Hospital Charge Code |
8799180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$232.87 |
| Max. Negotiated Rate |
$1,652.00 |
| Rate for Payer: Aetna of IA Medicare |
$232.87
|
| Rate for Payer: Amerigroup Medicaid |
$240.79
|
| Rate for Payer: Cash Price |
$1,888.00
|
| Rate for Payer: Cash Price |
$1,888.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$279.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$237.53
|
| Rate for Payer: Medical Associates Commercial |
$442.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$232.87
|
| Rate for Payer: Midlands Choice Commercial |
$1,652.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$349.30
|
| Rate for Payer: Wellmark IA HMO |
$504.00
|
| Rate for Payer: Wellmark IA PPO |
$591.00
|
|
|
45384 COLONOSCOPY W/ DESTRUCT/CAUT OF POLIP (HOT BX FORCEPS)
|
Professional
|
$1,488.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
8069190
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$203.83 |
| Max. Negotiated Rate |
$1,041.60 |
| Rate for Payer: Aetna of IA Medicare |
$203.83
|
| Rate for Payer: Amerigroup Medicaid |
$210.76
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$244.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$207.91
|
| Rate for Payer: Medical Associates Commercial |
$387.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$203.83
|
| Rate for Payer: Midlands Choice Commercial |
$1,041.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$305.74
|
| Rate for Payer: Wellmark IA HMO |
$444.00
|
| Rate for Payer: Wellmark IA PPO |
$521.00
|
|
|
45385 COLONOSCOPY W/ SNARE POLYPECTOMY (HOT OR COLD SNARE)
|
Professional
|
$1,410.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
8069017
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$228.57 |
| Max. Negotiated Rate |
$987.00 |
| Rate for Payer: Aetna of IA Medicare |
$228.57
|
| Rate for Payer: Amerigroup Medicaid |
$236.34
|
| Rate for Payer: Cash Price |
$1,128.00
|
| Rate for Payer: Cash Price |
$1,128.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$274.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$233.14
|
| Rate for Payer: Medical Associates Commercial |
$434.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$228.57
|
| Rate for Payer: Midlands Choice Commercial |
$987.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$342.86
|
| Rate for Payer: Wellmark IA HMO |
$494.00
|
| Rate for Payer: Wellmark IA PPO |
$580.00
|
|
|
45398 Colonoscopy flexible w/ band ligation of hemorrhoids
|
Professional
|
$2,274.00
|
|
|
Service Code
|
CPT 45398
|
| Hospital Charge Code |
8799181
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$210.33 |
| Max. Negotiated Rate |
$1,591.80 |
| Rate for Payer: Aetna of IA Medicare |
$210.33
|
| Rate for Payer: Amerigroup Medicaid |
$217.48
|
| Rate for Payer: Cash Price |
$1,819.20
|
| Rate for Payer: Cash Price |
$1,819.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$252.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$214.54
|
| Rate for Payer: Medical Associates Commercial |
$399.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$210.33
|
| Rate for Payer: Midlands Choice Commercial |
$1,591.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$315.50
|
| Rate for Payer: Wellmark IA HMO |
$460.00
|
| Rate for Payer: Wellmark IA PPO |
$540.00
|
|
|
45915 Removal fecal impaction or foreign body
|
Professional
|
$1,120.00
|
|
|
Service Code
|
CPT 45915
|
| Hospital Charge Code |
8799182
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$206.11 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna of IA Medicare |
$206.11
|
| Rate for Payer: Amerigroup Medicaid |
$213.12
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Cash Price |
$896.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$247.33
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$210.23
|
| Rate for Payer: Medical Associates Commercial |
$391.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$206.11
|
| Rate for Payer: Midlands Choice Commercial |
$784.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$309.16
|
| Rate for Payer: Wellmark IA HMO |
$437.00
|
| Rate for Payer: Wellmark IA PPO |
$513.00
|
|
|
4.5MM X 34MM HEADED SHORT THREAD SCREW
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8955183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.89 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna of IA Commercial |
$486.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$486.00
|
| Rate for Payer: Aetna of IA Medicare |
$307.80
|
| Rate for Payer: Amerigroup Medicaid |
$272.54
|
| Rate for Payer: Amerigroup Medicare |
$272.70
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$405.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$270.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$269.89
|
| Rate for Payer: Medical Associates Commercial |
$405.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$270.00
|
| Rate for Payer: Midlands Choice Commercial |
$378.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$274.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$405.00
|
| Rate for Payer: United Healthcare Commercial |
$486.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$318.60
|
|
|
4.5MM X 34MM HEADED SHORT THREAD SCREW
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8955183
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna of IA Commercial |
$486.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$486.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$405.00
|
| Rate for Payer: Medical Associates Commercial |
$405.00
|
| Rate for Payer: Midlands Choice Commercial |
$378.00
|
| Rate for Payer: United Healthcare Commercial |
$486.00
|
|
|
4.5mm x 36mm HEADED SHORT THREAD SCREW
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8955185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
4.5mm x 36mm HEADED SHORT THREAD SCREW
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8955185
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
4.5 X 32mm STTCS HEADED SHORT THREAD SCREW
|
Facility
IP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8829097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
|
|
4.5 X 32mm STTCS HEADED SHORT THREAD SCREW
|
Facility
OP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8829097
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Aetna of IA Medicare |
$292.41
|
| Rate for Payer: Amerigroup Medicaid |
$258.91
|
| Rate for Payer: Amerigroup Medicare |
$259.06
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$256.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$256.40
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$256.50
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$260.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$384.75
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$302.67
|
|
|
4.5x38MM STTCS HEADED SHORT THREAD SCREW
|
Facility
OP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.89 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna of IA Commercial |
$486.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$486.00
|
| Rate for Payer: Aetna of IA Medicare |
$307.80
|
| Rate for Payer: Amerigroup Medicaid |
$272.54
|
| Rate for Payer: Amerigroup Medicare |
$272.70
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$405.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$270.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$269.89
|
| Rate for Payer: Medical Associates Commercial |
$405.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$270.00
|
| Rate for Payer: Midlands Choice Commercial |
$378.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$274.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$405.00
|
| Rate for Payer: United Healthcare Commercial |
$486.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$318.60
|
|
|
4.5x38MM STTCS HEADED SHORT THREAD SCREW
|
Facility
IP
|
$540.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758579
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Aetna of IA Commercial |
$486.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$486.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$405.00
|
| Rate for Payer: Medical Associates Commercial |
$405.00
|
| Rate for Payer: Midlands Choice Commercial |
$378.00
|
| Rate for Payer: United Healthcare Commercial |
$486.00
|
|
|
4.5 X 40MM LTTCS HEADED LONG THREAD SCREWS
|
Facility
OP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Aetna of IA Medicare |
$292.41
|
| Rate for Payer: Amerigroup Medicaid |
$258.91
|
| Rate for Payer: Amerigroup Medicare |
$259.06
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$256.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$256.40
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$256.50
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$260.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$384.75
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$302.67
|
|
|
4.5 X 40MM LTTCS HEADED LONG THREAD SCREWS
|
Facility
IP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8812782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
|
|
4.5x45MM STTCS HEADED SHORT THREAD SCREW
|
Facility
OP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8824136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.40 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Aetna of IA Medicare |
$292.41
|
| Rate for Payer: Amerigroup Medicaid |
$258.91
|
| Rate for Payer: Amerigroup Medicare |
$259.06
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$256.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$256.40
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$256.50
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$260.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$384.75
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$302.67
|
|
|
4.5x45MM STTCS HEADED SHORT THREAD SCREW
|
Facility
IP
|
$513.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8824136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
|
|
46080 SPHINCTEROTOMY OR
|
Professional
|
$828.00
|
|
|
Service Code
|
CPT 46080
|
| Hospital Charge Code |
8069038
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$141.87 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna of IA Medicare |
$141.87
|
| Rate for Payer: Amerigroup Medicaid |
$146.69
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$170.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$144.71
|
| Rate for Payer: Medical Associates Commercial |
$269.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$141.87
|
| Rate for Payer: Midlands Choice Commercial |
$579.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$212.80
|
| Rate for Payer: Wellmark IA HMO |
$302.00
|
| Rate for Payer: Wellmark IA PPO |
$354.00
|
|
|
46083 INCISN THROMBD HEMMRHOID EXTER
|
Professional
|
$588.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
8069043
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$99.65 |
| Max. Negotiated Rate |
$411.60 |
| Rate for Payer: Aetna of IA Medicare |
$99.65
|
| Rate for Payer: Amerigroup Medicaid |
$103.04
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$101.64
|
| Rate for Payer: Medical Associates Commercial |
$189.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.65
|
| Rate for Payer: Midlands Choice Commercial |
$411.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$149.48
|
| Rate for Payer: Wellmark IA HMO |
$210.00
|
| Rate for Payer: Wellmark IA PPO |
$246.00
|
|
|
46200 FISSURECTOMY W-W/O SPHINCTRTMY
|
Professional
|
$1,488.00
|
|
|
Service Code
|
CPT 46200
|
| Hospital Charge Code |
8069003
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$307.85 |
| Max. Negotiated Rate |
$1,041.60 |
| Rate for Payer: Aetna of IA Medicare |
$307.85
|
| Rate for Payer: Amerigroup Medicaid |
$318.32
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$369.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$314.01
|
| Rate for Payer: Medical Associates Commercial |
$584.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$307.85
|
| Rate for Payer: Midlands Choice Commercial |
$1,041.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$461.78
|
| Rate for Payer: Wellmark IA HMO |
$647.00
|
| Rate for Payer: Wellmark IA PPO |
$759.00
|
|
|
46220 EXCISE ANAL EXT TAG/PAPILLA
|
Professional
|
$686.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
8069070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$110.12 |
| Max. Negotiated Rate |
$480.20 |
| Rate for Payer: Aetna of IA Medicare |
$110.12
|
| Rate for Payer: Amerigroup Medicaid |
$113.86
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$112.32
|
| Rate for Payer: Medical Associates Commercial |
$209.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.12
|
| Rate for Payer: Midlands Choice Commercial |
$480.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.18
|
| Rate for Payer: Wellmark IA HMO |
$232.00
|
| Rate for Payer: Wellmark IA PPO |
$272.00
|
|
|
46221 Hemorrhoid ligation
|
Professional
|
$900.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
8799183
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$174.89 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna of IA Medicare |
$174.89
|
| Rate for Payer: Amerigroup Medicaid |
$180.84
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$209.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$178.39
|
| Rate for Payer: Medical Associates Commercial |
$332.29
|
| Rate for Payer: Medical Associates Managed Medicare |
$174.89
|
| Rate for Payer: Midlands Choice Commercial |
$630.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$262.34
|
| Rate for Payer: Wellmark IA HMO |
$345.00
|
| Rate for Payer: Wellmark IA PPO |
$405.00
|
|
|
46250 REMOVE EXT HEMORRHOID 2 OR MORE COLUMNS/GROUPS
|
Professional
|
$1,544.00
|
|
|
Service Code
|
CPT 46250
|
| Hospital Charge Code |
8069023
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$287.76 |
| Max. Negotiated Rate |
$1,080.80 |
| Rate for Payer: Aetna of IA Medicare |
$287.76
|
| Rate for Payer: Amerigroup Medicaid |
$297.54
|
| Rate for Payer: Cash Price |
$1,235.20
|
| Rate for Payer: Cash Price |
$1,235.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$345.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$293.52
|
| Rate for Payer: Medical Associates Commercial |
$546.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$287.76
|
| Rate for Payer: Midlands Choice Commercial |
$1,080.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$431.64
|
| Rate for Payer: Wellmark IA HMO |
$610.00
|
| Rate for Payer: Wellmark IA PPO |
$716.00
|
|
|
46280 FISTULCTOMY COMPLX W-W/O SETON
|
Professional
|
$1,577.00
|
|
|
Service Code
|
CPT 46280
|
| Hospital Charge Code |
8069102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$435.71 |
| Max. Negotiated Rate |
$1,103.90 |
| Rate for Payer: Aetna of IA Medicare |
$435.71
|
| Rate for Payer: Amerigroup Medicaid |
$450.52
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$522.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$444.42
|
| Rate for Payer: Medical Associates Commercial |
$827.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$435.71
|
| Rate for Payer: Midlands Choice Commercial |
$1,103.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$653.56
|
| Rate for Payer: Wellmark IA HMO |
$921.00
|
| Rate for Payer: Wellmark IA PPO |
$1,081.00
|
|
|
46405 IncisionDrainage- superficial perianal abscess
|
Professional
|
$1,459.00
|
|
|
Service Code
|
CPT 46045
|
| Hospital Charge Code |
8799067
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.71 |
| Max. Negotiated Rate |
$1,021.30 |
| Rate for Payer: Aetna of IA Medicare |
$396.71
|
| Rate for Payer: Amerigroup Medicaid |
$410.20
|
| Rate for Payer: Cash Price |
$1,167.20
|
| Rate for Payer: Cash Price |
$1,167.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$476.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$404.64
|
| Rate for Payer: Medical Associates Commercial |
$753.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$396.71
|
| Rate for Payer: Midlands Choice Commercial |
$1,021.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$595.06
|
| Rate for Payer: Wellmark IA HMO |
$840.00
|
| Rate for Payer: Wellmark IA PPO |
$986.00
|
|
