|
46600 Anoscopy- diagnostic w/o bx
|
Professional
|
$297.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
8799188
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of IA Medicare |
$37.29
|
| Rate for Payer: Amerigroup Medicaid |
$38.56
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.04
|
| Rate for Payer: Medical Associates Commercial |
$70.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.29
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.94
|
| Rate for Payer: Wellmark IA HMO |
$78.00
|
| Rate for Payer: Wellmark IA PPO |
$92.00
|
|
|
46910 Destruction of lesion(s)- anus
|
Professional
|
$863.00
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
8799189
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$122.94 |
| Max. Negotiated Rate |
$604.10 |
| Rate for Payer: Aetna of IA Medicare |
$122.94
|
| Rate for Payer: Amerigroup Medicaid |
$127.12
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.40
|
| Rate for Payer: Medical Associates Commercial |
$233.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$122.94
|
| Rate for Payer: Midlands Choice Commercial |
$604.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$184.41
|
| Rate for Payer: Wellmark IA HMO |
$256.00
|
| Rate for Payer: Wellmark IA PPO |
$301.00
|
|
|
46946 Hemorroidectomy internal by ligation; 2 or more colums/groups
|
Professional
|
$1,070.00
|
|
|
Service Code
|
CPT 46946
|
| Hospital Charge Code |
8799190
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$345.42 |
| Max. Negotiated Rate |
$855.00 |
| Rate for Payer: Aetna of IA Medicare |
$345.42
|
| Rate for Payer: Amerigroup Medicaid |
$357.16
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$414.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$352.33
|
| Rate for Payer: Medical Associates Commercial |
$656.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$345.42
|
| Rate for Payer: Midlands Choice Commercial |
$749.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$518.13
|
| Rate for Payer: Wellmark IA HMO |
$728.00
|
| Rate for Payer: Wellmark IA PPO |
$855.00
|
|
|
47000 NEEDLE BX LIVER PERCUTANEOUS
|
Professional
|
$1,015.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
8069085
|
|
Hospital Revenue Code
|
974
|
| Min. Negotiated Rate |
$79.29 |
| Max. Negotiated Rate |
$710.50 |
| Rate for Payer: Aetna of IA Medicare |
$79.29
|
| Rate for Payer: Amerigroup Medicaid |
$81.99
|
| Rate for Payer: Cash Price |
$812.00
|
| Rate for Payer: Cash Price |
$812.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$95.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.88
|
| Rate for Payer: Medical Associates Commercial |
$150.65
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.29
|
| Rate for Payer: Midlands Choice Commercial |
$710.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$118.94
|
| Rate for Payer: Wellmark IA HMO |
$165.00
|
| Rate for Payer: Wellmark IA PPO |
$194.00
|
|
|
47100 Biopsy of liver wedge
|
Professional
|
$2,858.00
|
|
|
Service Code
|
CPT 47100
|
| Hospital Charge Code |
8799191
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$754.02 |
| Max. Negotiated Rate |
$2,000.60 |
| Rate for Payer: Aetna of IA Medicare |
$754.02
|
| Rate for Payer: Amerigroup Medicaid |
$779.66
|
| Rate for Payer: Cash Price |
$2,286.40
|
| Rate for Payer: Cash Price |
$2,286.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$904.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$769.10
|
| Rate for Payer: Medical Associates Commercial |
$1,432.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$754.02
|
| Rate for Payer: Midlands Choice Commercial |
$2,000.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,131.03
|
| Rate for Payer: Wellmark IA HMO |
$1,619.00
|
| Rate for Payer: Wellmark IA PPO |
$1,900.00
|
|
|
47562 CHOLECYSTECTOMY LAPAROSCOPIC
|
Professional
|
$2,220.00
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
8069033
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$585.93 |
| Max. Negotiated Rate |
$1,554.00 |
| Rate for Payer: Aetna of IA Medicare |
$585.93
|
| Rate for Payer: Amerigroup Medicaid |
$605.85
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$703.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$597.65
|
| Rate for Payer: Medical Associates Commercial |
$1,113.27
|
| Rate for Payer: Medical Associates Managed Medicare |
$585.93
|
| Rate for Payer: Midlands Choice Commercial |
$1,554.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$878.90
|
| Rate for Payer: Wellmark IA HMO |
$1,259.00
|
| Rate for Payer: Wellmark IA PPO |
$1,478.00
|
|
|
47563 CHOLECYSTECTOMY LAP W/CHOLANGI
|
Professional
|
$2,411.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
8068970
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$636.76 |
| Max. Negotiated Rate |
$1,687.70 |
| Rate for Payer: Aetna of IA Medicare |
$636.76
|
| Rate for Payer: Amerigroup Medicaid |
$658.41
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$764.11
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$649.50
|
| Rate for Payer: Medical Associates Commercial |
$1,209.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$636.76
|
| Rate for Payer: Midlands Choice Commercial |
$1,687.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$955.14
|
| Rate for Payer: Wellmark IA HMO |
$1,372.00
|
| Rate for Payer: Wellmark IA PPO |
$1,611.00
|
|
|
47564 LAP CHOLE W/ EXPLOR OF COMMON DUCT
|
Professional
|
$3,758.00
|
|
|
Service Code
|
CPT 47564
|
| Hospital Charge Code |
8068967
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$989.17 |
| Max. Negotiated Rate |
$2,630.60 |
| Rate for Payer: Aetna of IA Medicare |
$989.17
|
| Rate for Payer: Amerigroup Medicaid |
$1,022.80
|
| Rate for Payer: Cash Price |
$3,006.40
|
| Rate for Payer: Cash Price |
$3,006.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,187.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,008.95
|
| Rate for Payer: Medical Associates Commercial |
$1,879.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$989.17
|
| Rate for Payer: Midlands Choice Commercial |
$2,630.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,483.76
|
| Rate for Payer: Wellmark IA HMO |
$2,130.00
|
| Rate for Payer: Wellmark IA PPO |
$2,500.00
|
|
|
47600 CHOLECYSTECTOMY
|
Professional
|
$3,604.00
|
|
|
Service Code
|
CPT 47600
|
| Hospital Charge Code |
8069179
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$946.73 |
| Max. Negotiated Rate |
$2,522.80 |
| Rate for Payer: Aetna of IA Medicare |
$946.73
|
| Rate for Payer: Amerigroup Medicaid |
$978.92
|
| Rate for Payer: Cash Price |
$2,883.20
|
| Rate for Payer: Cash Price |
$2,883.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,136.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$965.66
|
| Rate for Payer: Medical Associates Commercial |
$1,798.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$946.73
|
| Rate for Payer: Midlands Choice Commercial |
$2,522.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,420.10
|
| Rate for Payer: Wellmark IA HMO |
$2,037.00
|
| Rate for Payer: Wellmark IA PPO |
$2,391.00
|
|
|
47605 Cholecystectomy; with cholangiography
|
Professional
|
$3,802.00
|
|
|
Service Code
|
CPT 47605
|
| Hospital Charge Code |
8799192
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$995.92 |
| Max. Negotiated Rate |
$2,661.40 |
| Rate for Payer: Aetna of IA Medicare |
$995.92
|
| Rate for Payer: Amerigroup Medicaid |
$1,029.78
|
| Rate for Payer: Cash Price |
$3,041.60
|
| Rate for Payer: Cash Price |
$3,041.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,195.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,015.84
|
| Rate for Payer: Medical Associates Commercial |
$1,892.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$995.92
|
| Rate for Payer: Midlands Choice Commercial |
$2,661.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,493.88
|
| Rate for Payer: Wellmark IA HMO |
$2,149.00
|
| Rate for Payer: Wellmark IA PPO |
$2,522.00
|
|
|
49000 LAPAROTOMY
|
Professional
|
$2,600.00
|
|
|
Service Code
|
CPT 49000
|
| Hospital Charge Code |
8069048
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$682.26 |
| Max. Negotiated Rate |
$1,820.00 |
| Rate for Payer: Aetna of IA Medicare |
$682.26
|
| Rate for Payer: Amerigroup Medicaid |
$705.46
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$818.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$695.91
|
| Rate for Payer: Medical Associates Commercial |
$1,296.29
|
| Rate for Payer: Medical Associates Managed Medicare |
$682.26
|
| Rate for Payer: Midlands Choice Commercial |
$1,820.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,023.39
|
| Rate for Payer: Wellmark IA HMO |
$1,463.00
|
| Rate for Payer: Wellmark IA PPO |
$1,717.00
|
|
|
49505 HERNIA REPR INIT INGUINAL>5YR
|
Professional
|
$1,754.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
8069140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$465.61 |
| Max. Negotiated Rate |
$1,227.80 |
| Rate for Payer: Aetna of IA Medicare |
$465.61
|
| Rate for Payer: Amerigroup Medicaid |
$481.44
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$558.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$474.92
|
| Rate for Payer: Medical Associates Commercial |
$884.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$465.61
|
| Rate for Payer: Midlands Choice Commercial |
$1,227.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$698.42
|
| Rate for Payer: Wellmark IA HMO |
$1,001.00
|
| Rate for Payer: Wellmark IA PPO |
$1,175.00
|
|
|
49507 Repair initial inguinal hernia age 5+ incarcerated/strangulated
|
Professional
|
$1,979.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
8799193
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$523.09 |
| Max. Negotiated Rate |
$1,385.30 |
| Rate for Payer: Aetna of IA Medicare |
$523.09
|
| Rate for Payer: Amerigroup Medicaid |
$540.88
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$627.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$533.55
|
| Rate for Payer: Medical Associates Commercial |
$993.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$523.09
|
| Rate for Payer: Midlands Choice Commercial |
$1,385.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$784.64
|
| Rate for Payer: Wellmark IA HMO |
$1,125.00
|
| Rate for Payer: Wellmark IA PPO |
$1,321.00
|
|
|
49520 HERNIA REP RECUR INGNL REDC ANY AGE
|
Professional
|
$2,131.00
|
|
|
Service Code
|
CPT 49520
|
| Hospital Charge Code |
8069154
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$562.88 |
| Max. Negotiated Rate |
$1,491.70 |
| Rate for Payer: Aetna of IA Medicare |
$562.88
|
| Rate for Payer: Amerigroup Medicaid |
$582.02
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$675.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$574.14
|
| Rate for Payer: Medical Associates Commercial |
$1,069.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$562.88
|
| Rate for Payer: Midlands Choice Commercial |
$1,491.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$844.32
|
| Rate for Payer: Wellmark IA HMO |
$1,210.00
|
| Rate for Payer: Wellmark IA PPO |
$1,421.00
|
|
|
49521 HERNIA REPR INIT HERNIA ANY AGE
|
Professional
|
$2,417.00
|
|
|
Service Code
|
CPT 49521
|
| Hospital Charge Code |
8069069
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$636.04 |
| Max. Negotiated Rate |
$1,691.90 |
| Rate for Payer: Aetna of IA Medicare |
$636.04
|
| Rate for Payer: Amerigroup Medicaid |
$657.67
|
| Rate for Payer: Cash Price |
$1,933.60
|
| Rate for Payer: Cash Price |
$1,933.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$763.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$648.76
|
| Rate for Payer: Medical Associates Commercial |
$1,208.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$636.04
|
| Rate for Payer: Midlands Choice Commercial |
$1,691.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$954.06
|
| Rate for Payer: Wellmark IA HMO |
$1,370.00
|
| Rate for Payer: Wellmark IA PPO |
$1,608.00
|
|
|
49525 HERNIA INGUINAL SLIDING
|
Professional
|
$1,932.00
|
|
|
Service Code
|
CPT 49525
|
| Hospital Charge Code |
8069139
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$510.38 |
| Max. Negotiated Rate |
$1,352.40 |
| Rate for Payer: Aetna of IA Medicare |
$510.38
|
| Rate for Payer: Amerigroup Medicaid |
$527.73
|
| Rate for Payer: Cash Price |
$1,545.60
|
| Rate for Payer: Cash Price |
$1,545.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$612.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$520.59
|
| Rate for Payer: Medical Associates Commercial |
$969.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$510.38
|
| Rate for Payer: Midlands Choice Commercial |
$1,352.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$765.57
|
| Rate for Payer: Wellmark IA HMO |
$1,098.00
|
| Rate for Payer: Wellmark IA PPO |
$1,289.00
|
|
|
49550 HERNIA - FEMORAL
|
Professional
|
$1,940.00
|
|
|
Service Code
|
CPT 49550
|
| Hospital Charge Code |
8069074
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$514.14 |
| Max. Negotiated Rate |
$1,358.00 |
| Rate for Payer: Aetna of IA Medicare |
$514.14
|
| Rate for Payer: Amerigroup Medicaid |
$531.62
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Cash Price |
$1,552.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$616.97
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$524.42
|
| Rate for Payer: Medical Associates Commercial |
$976.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$514.14
|
| Rate for Payer: Midlands Choice Commercial |
$1,358.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$771.21
|
| Rate for Payer: Wellmark IA HMO |
$1,106.00
|
| Rate for Payer: Wellmark IA PPO |
$1,298.00
|
|
|
49560 HERNIA REPR INIT INCIS/VEN R O
|
Professional
|
$2,489.00
|
|
|
Service Code
|
CPT 49560
|
| Hospital Charge Code |
8069088
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$1,742.30 |
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Cash Price |
$1,991.20
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,742.30
|
| Rate for Payer: Wellmark IA HMO |
$1,405.00
|
| Rate for Payer: Wellmark IA PPO |
$1,652.00
|
|
|
49561 HERNIA REPR INIT INC/VENT INCA
|
Professional
|
$3,139.00
|
|
|
Service Code
|
CPT 49561
|
| Hospital Charge Code |
8069000
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$2,197.30 |
| Rate for Payer: Cash Price |
$2,511.20
|
| Rate for Payer: Cash Price |
$2,511.20
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,197.30
|
| Rate for Payer: Wellmark IA HMO |
$1,767.00
|
| Rate for Payer: Wellmark IA PPO |
$2,079.00
|
|
|
49565 HERNIA REPR RECUR INC/VENT REDUCIBLE
|
Professional
|
$2,592.00
|
|
|
Service Code
|
CPT 49565
|
| Hospital Charge Code |
8069002
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$1,814.40 |
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,814.40
|
| Rate for Payer: Wellmark IA HMO |
$1,462.00
|
| Rate for Payer: Wellmark IA PPO |
$1,720.00
|
|
|
49566 HERNIA REPR REC INC VENT INC O
|
Professional
|
$3,167.00
|
|
|
Service Code
|
CPT 49566
|
| Hospital Charge Code |
8069056
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$2,216.90 |
| Rate for Payer: Cash Price |
$2,533.60
|
| Rate for Payer: Cash Price |
$2,533.60
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,216.90
|
| Rate for Payer: Wellmark IA HMO |
$1,782.00
|
| Rate for Payer: Wellmark IA PPO |
$2,097.00
|
|
|
49568 HERNIA REPAIR WITH MESH IMPLANT
|
Professional
|
$905.00
|
|
|
Service Code
|
CPT 49568
|
| Hospital Charge Code |
8068964
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$633.50 |
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Cash Price |
$724.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$633.50
|
| Rate for Payer: Wellmark IA HMO |
$503.00
|
| Rate for Payer: Wellmark IA PPO |
$591.00
|
|
|
49570 HERNIA REP EPIGASTRIC
|
Professional
|
$1,403.00
|
|
|
Service Code
|
CPT 49570
|
| Hospital Charge Code |
8069143
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$982.10 |
| Rate for Payer: Cash Price |
$1,122.40
|
| Rate for Payer: Cash Price |
$1,122.40
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$982.10
|
| Rate for Payer: Wellmark IA HMO |
$801.00
|
| Rate for Payer: Wellmark IA PPO |
$942.00
|
|
|
49585 HERNIA UMBILICAL > AGE 5
|
Professional
|
$1,499.00
|
|
|
Service Code
|
CPT 49585
|
| Hospital Charge Code |
8069162
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$1,049.30 |
| Rate for Payer: Cash Price |
$1,199.20
|
| Rate for Payer: Cash Price |
$1,199.20
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,049.30
|
| Rate for Payer: Wellmark IA HMO |
$854.00
|
| Rate for Payer: Wellmark IA PPO |
$1,005.00
|
|
|
49587 HERNIA REPR UMBIL INCARC >5YR
|
Professional
|
$1,600.00
|
|
|
Service Code
|
CPT 49587
|
| Hospital Charge Code |
8068963
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Cash Price |
$1,280.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,120.00
|
| Rate for Payer: Wellmark IA HMO |
$912.00
|
| Rate for Payer: Wellmark IA PPO |
$1,073.00
|
|
