|
58350 Chromotubation of oviduct
|
Professional
|
$422.00
|
|
|
Service Code
|
CPT 58350
|
| Hospital Charge Code |
8799202
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$86.43 |
| Max. Negotiated Rate |
$295.40 |
| Rate for Payer: Aetna of IA Medicare |
$86.43
|
| Rate for Payer: Amerigroup Medicaid |
$89.37
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$88.16
|
| Rate for Payer: Medical Associates Commercial |
$164.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$86.43
|
| Rate for Payer: Midlands Choice Commercial |
$295.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$129.64
|
| Rate for Payer: Wellmark IA HMO |
$183.00
|
| Rate for Payer: Wellmark IA PPO |
$215.00
|
|
|
58561 Hysteroscopy surgical; w/ removal of leiomyomata
|
Professional
|
$1,201.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
8799203
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$321.81 |
| Max. Negotiated Rate |
$840.70 |
| Rate for Payer: Aetna of IA Medicare |
$321.81
|
| Rate for Payer: Amerigroup Medicaid |
$332.75
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$386.17
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$328.25
|
| Rate for Payer: Medical Associates Commercial |
$611.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$321.81
|
| Rate for Payer: Midlands Choice Commercial |
$840.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$482.72
|
| Rate for Payer: Wellmark IA HMO |
$679.00
|
| Rate for Payer: Wellmark IA PPO |
$796.00
|
|
|
58600 TUBAL LIGATION
|
Professional
|
$1,201.00
|
|
|
Service Code
|
CPT 58600
|
| Hospital Charge Code |
8068988
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$337.48 |
| Max. Negotiated Rate |
$840.70 |
| Rate for Payer: Aetna of IA Medicare |
$337.48
|
| Rate for Payer: Amerigroup Medicaid |
$348.95
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$404.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$344.23
|
| Rate for Payer: Medical Associates Commercial |
$641.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$337.48
|
| Rate for Payer: Midlands Choice Commercial |
$840.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$506.22
|
| Rate for Payer: Wellmark IA HMO |
$711.00
|
| Rate for Payer: Wellmark IA PPO |
$835.00
|
|
|
58605 TUBAL LIGATION POST PARTUM
|
Professional
|
$1,088.00
|
|
|
Service Code
|
CPT 58605
|
| Hospital Charge Code |
8068982
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$306.84 |
| Max. Negotiated Rate |
$761.60 |
| Rate for Payer: Aetna of IA Medicare |
$306.84
|
| Rate for Payer: Amerigroup Medicaid |
$317.27
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$368.21
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$312.98
|
| Rate for Payer: Medical Associates Commercial |
$583.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$306.84
|
| Rate for Payer: Midlands Choice Commercial |
$761.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$460.26
|
| Rate for Payer: Wellmark IA HMO |
$647.00
|
| Rate for Payer: Wellmark IA PPO |
$759.00
|
|
|
58611 TUBAL LIGATION W/OTHER PROC
|
Professional
|
$255.00
|
|
|
Service Code
|
CPT 58611
|
| Hospital Charge Code |
8069138
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$67.81 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna of IA Medicare |
$67.81
|
| Rate for Payer: Amerigroup Medicaid |
$70.12
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.17
|
| Rate for Payer: Medical Associates Commercial |
$128.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.81
|
| Rate for Payer: Midlands Choice Commercial |
$178.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.72
|
| Rate for Payer: Wellmark IA HMO |
$144.00
|
| Rate for Payer: Wellmark IA PPO |
$169.00
|
|
|
58670 LAP TUBAL W/ DESTRUCTION OF OVIDUCTS
|
Professional
|
$1,207.00
|
|
|
Service Code
|
CPT 58670
|
| Hospital Charge Code |
8069144
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$338.08 |
| Max. Negotiated Rate |
$844.90 |
| Rate for Payer: Aetna of IA Medicare |
$338.08
|
| Rate for Payer: Amerigroup Medicaid |
$349.57
|
| Rate for Payer: Cash Price |
$965.60
|
| Rate for Payer: Cash Price |
$965.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$405.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$344.84
|
| Rate for Payer: Medical Associates Commercial |
$642.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$338.08
|
| Rate for Payer: Midlands Choice Commercial |
$844.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$507.12
|
| Rate for Payer: Wellmark IA HMO |
$712.00
|
| Rate for Payer: Wellmark IA PPO |
$836.00
|
|
|
58671 Laparoscopy surgical; w/ occlusion of oviducts by device
|
Professional
|
$1,197.00
|
|
|
Service Code
|
CPT 58671
|
| Hospital Charge Code |
8799204
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$338.08 |
| Max. Negotiated Rate |
$837.90 |
| Rate for Payer: Aetna of IA Medicare |
$338.08
|
| Rate for Payer: Amerigroup Medicaid |
$349.57
|
| Rate for Payer: Cash Price |
$957.60
|
| Rate for Payer: Cash Price |
$957.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$405.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$344.84
|
| Rate for Payer: Medical Associates Commercial |
$642.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$338.08
|
| Rate for Payer: Midlands Choice Commercial |
$837.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$507.12
|
| Rate for Payer: Wellmark IA HMO |
$712.00
|
| Rate for Payer: Wellmark IA PPO |
$836.00
|
|
|
58720 SALPINGO-OOPHORECTOMY
|
Professional
|
$2,459.00
|
|
|
Service Code
|
CPT 58720
|
| Hospital Charge Code |
8069040
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$688.94 |
| Max. Negotiated Rate |
$1,721.30 |
| Rate for Payer: Aetna of IA Medicare |
$688.94
|
| Rate for Payer: Amerigroup Medicaid |
$712.36
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Cash Price |
$1,967.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$826.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$702.72
|
| Rate for Payer: Medical Associates Commercial |
$1,308.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$688.94
|
| Rate for Payer: Midlands Choice Commercial |
$1,721.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,033.41
|
| Rate for Payer: Wellmark IA HMO |
$1,449.00
|
| Rate for Payer: Wellmark IA PPO |
$1,701.00
|
|
|
58925 OVARIAN CYSTECTOMY W/HYSTERECT
|
Professional
|
$2,484.00
|
|
|
Service Code
|
CPT 58925
|
| Hospital Charge Code |
8068997
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$1,738.80 |
| Rate for Payer: Aetna of IA Medicare |
$693.00
|
| Rate for Payer: Amerigroup Medicaid |
$716.56
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$831.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$706.86
|
| Rate for Payer: Medical Associates Commercial |
$1,316.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$693.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,738.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,039.50
|
| Rate for Payer: Wellmark IA HMO |
$1,469.00
|
| Rate for Payer: Wellmark IA PPO |
$1,724.00
|
|
|
58940 OOPHORECTOMY
|
Professional
|
$1,754.00
|
|
|
Service Code
|
CPT 58940
|
| Hospital Charge Code |
8069191
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$502.37 |
| Max. Negotiated Rate |
$1,252.00 |
| Rate for Payer: Aetna of IA Medicare |
$502.37
|
| Rate for Payer: Amerigroup Medicaid |
$519.45
|
| 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 |
$602.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$512.42
|
| Rate for Payer: Medical Associates Commercial |
$954.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$502.37
|
| Rate for Payer: Midlands Choice Commercial |
$1,227.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$753.56
|
| Rate for Payer: Wellmark IA HMO |
$1,067.00
|
| Rate for Payer: Wellmark IA PPO |
$1,252.00
|
|
|
59514 C-SECTION
|
Professional
|
$3,100.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
8069081
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$788.63 |
| Max. Negotiated Rate |
$2,170.00 |
| Rate for Payer: Aetna of IA Medicare |
$788.63
|
| Rate for Payer: Amerigroup Medicaid |
$815.44
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Cash Price |
$2,480.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$946.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$804.40
|
| Rate for Payer: Medical Associates Commercial |
$1,498.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$788.63
|
| Rate for Payer: Midlands Choice Commercial |
$2,170.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,182.94
|
| Rate for Payer: Wellmark IA HMO |
$1,125.00
|
| Rate for Payer: Wellmark IA PPO |
$1,320.00
|
|
|
59820 Treatment of missed abortion- 1st trimester
|
Professional
|
$1,270.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
8799205
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$343.71 |
| Max. Negotiated Rate |
$889.00 |
| Rate for Payer: Aetna of IA Medicare |
$343.71
|
| Rate for Payer: Amerigroup Medicaid |
$355.40
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Cash Price |
$1,016.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$412.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$350.58
|
| Rate for Payer: Medical Associates Commercial |
$653.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$343.71
|
| Rate for Payer: Midlands Choice Commercial |
$889.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$515.56
|
| Rate for Payer: Wellmark IA HMO |
$743.00
|
| Rate for Payer: Wellmark IA PPO |
$873.00
|
|
|
60220 THYROID LOBECTOMY TOTAL
|
Professional
|
$2,370.00
|
|
|
Service Code
|
CPT 60220
|
| Hospital Charge Code |
8068978
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$637.00 |
| Max. Negotiated Rate |
$1,659.00 |
| Rate for Payer: Aetna of IA Medicare |
$637.00
|
| Rate for Payer: Amerigroup Medicaid |
$658.66
|
| Rate for Payer: Cash Price |
$1,896.00
|
| Rate for Payer: Cash Price |
$1,896.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$764.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$649.74
|
| Rate for Payer: Medical Associates Commercial |
$1,210.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$637.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,659.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$955.50
|
| Rate for Payer: Wellmark IA HMO |
$1,351.00
|
| Rate for Payer: Wellmark IA PPO |
$1,585.00
|
|
|
62321 Spinal injection steroid- cervical/thoracic with fluoroscopic guidance
|
Professional
|
$860.00
|
|
|
Service Code
|
CPT 62321
|
| Hospital Charge Code |
8799206
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$98.38 |
| Max. Negotiated Rate |
$602.00 |
| Rate for Payer: Aetna of IA Medicare |
$98.38
|
| Rate for Payer: Amerigroup Medicaid |
$101.72
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Cash Price |
$688.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$100.35
|
| Rate for Payer: Medical Associates Commercial |
$186.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.38
|
| Rate for Payer: Midlands Choice Commercial |
$602.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.57
|
| Rate for Payer: Wellmark IA HMO |
$188.00
|
| Rate for Payer: Wellmark IA PPO |
$221.00
|
|
|
62323 Spinal injection steroid- lumbar/sacral with fluoroscopic guidance
|
Professional
|
$808.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
8799211
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$90.93 |
| Max. Negotiated Rate |
$565.60 |
| Rate for Payer: Aetna of IA Medicare |
$90.93
|
| Rate for Payer: Amerigroup Medicaid |
$94.02
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Cash Price |
$646.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$92.75
|
| Rate for Payer: Medical Associates Commercial |
$172.77
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.93
|
| Rate for Payer: Midlands Choice Commercial |
$565.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$136.40
|
| Rate for Payer: Wellmark IA HMO |
$175.00
|
| Rate for Payer: Wellmark IA PPO |
$205.00
|
|
|
6.25MM MALYUGIN RING
|
Facility
OP
|
$157.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8884865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$78.72 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of IA Commercial |
$141.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.75
|
| Rate for Payer: Aetna of IA Medicare |
$89.78
|
| Rate for Payer: Amerigroup Medicaid |
$79.49
|
| Rate for Payer: Amerigroup Medicare |
$79.54
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.72
|
| Rate for Payer: Medical Associates Commercial |
$118.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$110.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$118.12
|
| Rate for Payer: United Healthcare Commercial |
$141.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.92
|
|
|
6.25MM MALYUGIN RING
|
Facility
IP
|
$157.50
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8884865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$141.75 |
| Rate for Payer: Aetna of IA Commercial |
$141.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.75
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$118.12
|
| Rate for Payer: Medical Associates Commercial |
$118.12
|
| Rate for Payer: Midlands Choice Commercial |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$141.75
|
|
|
64405 Occipital nerve block (can only be reported once-even if bilateral)
|
Professional
|
$332.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
8799212
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$46.63 |
| Max. Negotiated Rate |
$232.40 |
| Rate for Payer: Aetna of IA Medicare |
$46.63
|
| Rate for Payer: Amerigroup Medicaid |
$48.22
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.56
|
| Rate for Payer: Medical Associates Commercial |
$88.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.63
|
| Rate for Payer: Midlands Choice Commercial |
$232.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.94
|
| Rate for Payer: Wellmark IA HMO |
$94.00
|
| Rate for Payer: Wellmark IA PPO |
$110.00
|
|
|
64451 INJ AA/STRD Nerves NRVTG SI Joint W/IMG
|
Professional
|
$699.00
|
|
|
Service Code
|
CPT 64451
|
| Hospital Charge Code |
8801477
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$74.89 |
| Max. Negotiated Rate |
$489.30 |
| Rate for Payer: Aetna of IA Medicare |
$74.89
|
| Rate for Payer: Amerigroup Medicaid |
$77.44
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$89.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.39
|
| Rate for Payer: Medical Associates Commercial |
$142.29
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.89
|
| Rate for Payer: Midlands Choice Commercial |
$489.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$112.34
|
| Rate for Payer: Wellmark IA HMO |
$144.00
|
| Rate for Payer: Wellmark IA PPO |
$169.00
|
|
|
64454 Injection genicular nerve branches incl/ imaging when guidance
|
Professional
|
$706.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
8799213
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.48 |
| Max. Negotiated Rate |
$494.20 |
| Rate for Payer: Aetna of IA Medicare |
$75.48
|
| Rate for Payer: Amerigroup Medicaid |
$78.05
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Cash Price |
$564.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.99
|
| Rate for Payer: Medical Associates Commercial |
$143.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.48
|
| Rate for Payer: Midlands Choice Commercial |
$494.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.22
|
| Rate for Payer: Wellmark IA HMO |
$145.00
|
| Rate for Payer: Wellmark IA PPO |
$170.00
|
|
|
64479 INJ Foramen Epidural C/T
|
Professional
|
$847.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
8801475
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$119.68 |
| Max. Negotiated Rate |
$592.90 |
| Rate for Payer: Aetna of IA Medicare |
$119.68
|
| Rate for Payer: Amerigroup Medicaid |
$123.75
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Cash Price |
$677.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$143.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$122.07
|
| Rate for Payer: Medical Associates Commercial |
$227.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$119.68
|
| Rate for Payer: Midlands Choice Commercial |
$592.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$179.52
|
| Rate for Payer: Wellmark IA HMO |
$230.00
|
| Rate for Payer: Wellmark IA PPO |
$270.00
|
|
|
64480 INJ Foramen Epidural Add-On
|
Professional
|
$421.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
8801476
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$55.89 |
| Max. Negotiated Rate |
$294.70 |
| Rate for Payer: Aetna of IA Medicare |
$55.89
|
| Rate for Payer: Amerigroup Medicaid |
$57.79
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Cash Price |
$336.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$67.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.01
|
| Rate for Payer: Medical Associates Commercial |
$106.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.89
|
| Rate for Payer: Midlands Choice Commercial |
$294.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.84
|
| Rate for Payer: Wellmark IA HMO |
$108.00
|
| Rate for Payer: Wellmark IA PPO |
$127.00
|
|
|
64561 PERCUTANEOUS IMPLANT NEUROELECTRODES
|
Professional
|
$2,732.00
|
|
|
Service Code
|
CPT 64561
|
| Hospital Charge Code |
8068904
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.30 |
| Max. Negotiated Rate |
$1,912.40 |
| Rate for Payer: Aetna of IA Medicare |
$275.30
|
| Rate for Payer: Amerigroup Medicaid |
$284.66
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Cash Price |
$2,185.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$330.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$280.81
|
| Rate for Payer: Medical Associates Commercial |
$523.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$275.30
|
| Rate for Payer: Midlands Choice Commercial |
$1,912.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$412.95
|
| Rate for Payer: Wellmark IA HMO |
$572.00
|
| Rate for Payer: Wellmark IA PPO |
$672.00
|
|
|
64581 INCISION FOR IMPLANT NEUROELECTRODES
|
Professional
|
$2,232.00
|
|
|
Service Code
|
CPT 64581
|
| Hospital Charge Code |
8068905
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$596.22 |
| Max. Negotiated Rate |
$1,562.40 |
| Rate for Payer: Aetna of IA Medicare |
$596.22
|
| Rate for Payer: Amerigroup Medicaid |
$616.49
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Cash Price |
$1,785.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$715.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$608.14
|
| Rate for Payer: Medical Associates Commercial |
$1,132.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$596.22
|
| Rate for Payer: Midlands Choice Commercial |
$1,562.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$894.33
|
| Rate for Payer: Wellmark IA HMO |
$1,239.00
|
| Rate for Payer: Wellmark IA PPO |
$1,454.00
|
|
|
64590 INSERTION/REPLACEMENT OF NEUROSTIMULATOR GEN OR REC
|
Professional
|
$882.00
|
|
|
Service Code
|
CPT 64590
|
| Hospital Charge Code |
8068906
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$267.61 |
| Max. Negotiated Rate |
$617.40 |
| Rate for Payer: Aetna of IA Medicare |
$267.61
|
| Rate for Payer: Amerigroup Medicaid |
$276.71
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Cash Price |
$705.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$321.13
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$272.96
|
| Rate for Payer: Medical Associates Commercial |
$508.46
|
| Rate for Payer: Medical Associates Managed Medicare |
$267.61
|
| Rate for Payer: Midlands Choice Commercial |
$617.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$401.42
|
| Rate for Payer: Wellmark IA HMO |
$305.00
|
| Rate for Payer: Wellmark IA PPO |
$358.00
|
|
