|
4.5x45MM STTCS HEADED SHORT THREAD SCREW
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8824136
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.85 |
| 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 |
$295.90
|
| Rate for Payer: Amerigroup Medicare |
$233.16
|
| 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 |
$230.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$293.03
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$230.85
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$297.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$265.48
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$302.67
|
|
|
46080 SPHINCTEROTOMY OR
|
Professional
|
Both
|
$828.00
|
|
|
Service Code
|
CPT 46080
|
| Hospital Charge Code |
8069038
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$188.81 |
| Max. Negotiated Rate |
$652.20 |
| Rate for Payer: Amerigroup Medicaid |
$190.66
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$188.81
|
| Rate for Payer: Medical Associates Commercial |
$621.00
|
| Rate for Payer: Midlands Choice Commercial |
$579.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$189.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$621.00
|
| Rate for Payer: United Healthcare Commercial |
$404.67
|
| Rate for Payer: Wellmark IA HMO WHPI |
$554.40
|
| Rate for Payer: Wellmark IA PPO |
$652.20
|
|
|
46083 INCISN THROMBD HEMMRHOID EXTER
|
Professional
|
Both
|
$588.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
8069043
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.05 |
| Max. Negotiated Rate |
$472.80 |
| Rate for Payer: Amerigroup Medicaid |
$137.38
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Cash Price |
$470.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$136.05
|
| Rate for Payer: Medical Associates Commercial |
$441.00
|
| Rate for Payer: Midlands Choice Commercial |
$411.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$136.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$441.00
|
| Rate for Payer: United Healthcare Commercial |
$289.36
|
| Rate for Payer: Wellmark IA HMO WHPI |
$401.80
|
| Rate for Payer: Wellmark IA PPO |
$472.80
|
|
|
46200 FISSURECTOMY W-W/O SPHINCTRTMY
|
Professional
|
Both
|
$1,488.00
|
|
|
Service Code
|
CPT 46200
|
| Hospital Charge Code |
8069003
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$247.83 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Amerigroup Medicaid |
$250.26
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Cash Price |
$1,190.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$247.83
|
| Rate for Payer: Medical Associates Commercial |
$1,116.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,041.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$249.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,116.00
|
| Rate for Payer: United Healthcare Commercial |
$695.94
|
| Rate for Payer: Wellmark IA HMO WHPI |
$918.40
|
| Rate for Payer: Wellmark IA PPO |
$1,080.50
|
|
|
46220 EXCISE ANAL EXT TAG/PAPILLA
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
CPT 46220
|
| Hospital Charge Code |
8069070
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Amerigroup Medicaid |
$92.03
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.14
|
| Rate for Payer: Medical Associates Commercial |
$514.50
|
| Rate for Payer: Midlands Choice Commercial |
$480.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$514.50
|
| Rate for Payer: United Healthcare Commercial |
$343.36
|
| Rate for Payer: Wellmark IA HMO WHPI |
$484.50
|
| Rate for Payer: Wellmark IA PPO |
$570.00
|
|
|
46221 Hemorrhoid ligation
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
8799183
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$114.18 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Amerigroup Medicaid |
$115.30
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.18
|
| Rate for Payer: Medical Associates Commercial |
$675.00
|
| Rate for Payer: Midlands Choice Commercial |
$630.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$675.00
|
| Rate for Payer: United Healthcare Commercial |
$414.35
|
| Rate for Payer: Wellmark IA HMO WHPI |
$546.70
|
| Rate for Payer: Wellmark IA PPO |
$643.20
|
|
|
46250 REMOVE EXT HEMORRHOID 2 OR MORE COLUMNS/GROUPS
|
Professional
|
Both
|
$1,544.00
|
|
|
Service Code
|
CPT 46250
|
| Hospital Charge Code |
8069023
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$307.91 |
| Max. Negotiated Rate |
$1,158.00 |
| Rate for Payer: Amerigroup Medicaid |
$310.93
|
| Rate for Payer: Cash Price |
$1,235.20
|
| Rate for Payer: Cash Price |
$1,235.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$307.91
|
| Rate for Payer: Medical Associates Commercial |
$1,158.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,080.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$309.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,158.00
|
| Rate for Payer: United Healthcare Commercial |
$714.11
|
| Rate for Payer: Wellmark IA HMO WHPI |
$923.50
|
| Rate for Payer: Wellmark IA PPO |
$1,086.50
|
|
|
46280 FISTULCTOMY COMPLX W-W/O SETON
|
Professional
|
Both
|
$1,577.00
|
|
|
Service Code
|
CPT 46280
|
| Hospital Charge Code |
8069102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$395.62 |
| Max. Negotiated Rate |
$1,182.75 |
| Rate for Payer: Amerigroup Medicaid |
$399.50
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Cash Price |
$1,261.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$395.62
|
| Rate for Payer: Medical Associates Commercial |
$1,182.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,103.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$397.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,182.75
|
| Rate for Payer: United Healthcare Commercial |
$722.51
|
| Rate for Payer: Wellmark IA HMO WHPI |
$931.20
|
| Rate for Payer: Wellmark IA PPO |
$1,095.60
|
|
|
46405 IncisionDrainage- superficial perianal abscess
|
Professional
|
Both
|
$1,459.00
|
|
|
Service Code
|
CPT 46045
|
| Hospital Charge Code |
8799067
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$241.70 |
| Max. Negotiated Rate |
$1,094.25 |
| Rate for Payer: Amerigroup Medicaid |
$244.07
|
| Rate for Payer: Cash Price |
$1,167.20
|
| Rate for Payer: Cash Price |
$1,167.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$241.70
|
| Rate for Payer: Medical Associates Commercial |
$1,094.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,021.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$242.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,094.25
|
| Rate for Payer: United Healthcare Commercial |
$661.94
|
| Rate for Payer: Wellmark IA HMO WHPI |
$853.00
|
| Rate for Payer: Wellmark IA PPO |
$1,003.60
|
|
|
46600 Anoscopy- diagnostic w/o bx
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
8799188
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$80.43 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: Amerigroup Medicaid |
$81.22
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Cash Price |
$237.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.43
|
| Rate for Payer: Medical Associates Commercial |
$222.75
|
| Rate for Payer: Midlands Choice Commercial |
$207.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$222.75
|
| Rate for Payer: United Healthcare Commercial |
$154.42
|
| Rate for Payer: Wellmark IA HMO WHPI |
$226.90
|
| Rate for Payer: Wellmark IA PPO |
$266.90
|
|
|
46910 Destruction of lesion(s)- anus
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
8799189
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$647.25 |
| Rate for Payer: Amerigroup Medicaid |
$140.00
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$138.64
|
| Rate for Payer: Medical Associates Commercial |
$647.25
|
| Rate for Payer: Midlands Choice Commercial |
$604.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$139.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$647.25
|
| Rate for Payer: United Healthcare Commercial |
$388.93
|
| Rate for Payer: Wellmark IA HMO WHPI |
$510.80
|
| Rate for Payer: Wellmark IA PPO |
$600.90
|
|
|
46946 Hemorroidectomy internal by ligation; 2 or more colums/groups
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
CPT 46946
|
| Hospital Charge Code |
8799190
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$207.50 |
| Max. Negotiated Rate |
$865.60 |
| Rate for Payer: Amerigroup Medicaid |
$209.53
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$207.50
|
| Rate for Payer: Medical Associates Commercial |
$802.50
|
| Rate for Payer: Midlands Choice Commercial |
$749.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$208.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$802.50
|
| Rate for Payer: United Healthcare Commercial |
$572.30
|
| Rate for Payer: Wellmark IA HMO WHPI |
$735.80
|
| Rate for Payer: Wellmark IA PPO |
$865.60
|
|
|
47000 NEEDLE BX LIVER PERCUTANEOUS
|
Professional
|
Both
|
$1,015.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
8069085
|
|
Hospital Revenue Code
|
974
|
| Min. Negotiated Rate |
$220.10 |
| Max. Negotiated Rate |
$761.25 |
| Rate for Payer: Amerigroup Medicaid |
$222.25
|
| Rate for Payer: Cash Price |
$812.00
|
| Rate for Payer: Cash Price |
$812.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$220.10
|
| Rate for Payer: Medical Associates Commercial |
$761.25
|
| Rate for Payer: Midlands Choice Commercial |
$710.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$221.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$761.25
|
| Rate for Payer: United Healthcare Commercial |
$468.74
|
| Rate for Payer: Wellmark IA HMO WHPI |
$572.30
|
| Rate for Payer: Wellmark IA PPO |
$673.30
|
|
|
47100 Biopsy of liver wedge
|
Professional
|
Both
|
$2,858.00
|
|
|
Service Code
|
CPT 47100
|
| Hospital Charge Code |
8799191
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$425.35 |
| Max. Negotiated Rate |
$2,143.50 |
| Rate for Payer: Amerigroup Medicaid |
$429.52
|
| Rate for Payer: Cash Price |
$2,286.40
|
| Rate for Payer: Cash Price |
$2,286.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$425.35
|
| Rate for Payer: Medical Associates Commercial |
$2,143.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,000.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$427.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,143.50
|
| Rate for Payer: United Healthcare Commercial |
$1,275.58
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,640.10
|
| Rate for Payer: Wellmark IA PPO |
$1,929.50
|
|
|
47562 CHOLECYSTECTOMY LAPAROSCOPIC
|
Professional
|
Both
|
$2,220.00
|
|
|
Service Code
|
CPT 47562
|
| Hospital Charge Code |
8069033
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$646.68 |
| Max. Negotiated Rate |
$1,665.00 |
| Rate for Payer: Amerigroup Medicaid |
$653.02
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Cash Price |
$1,776.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$646.68
|
| Rate for Payer: Medical Associates Commercial |
$1,665.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,554.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$649.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,665.00
|
| Rate for Payer: United Healthcare Commercial |
$991.54
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,276.70
|
| Rate for Payer: Wellmark IA PPO |
$1,502.00
|
|
|
47563 CHOLECYSTECTOMY LAP W/CHOLANGI
|
Professional
|
Both
|
$2,411.00
|
|
|
Service Code
|
CPT 47563
|
| Hospital Charge Code |
8068970
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$695.69 |
| Max. Negotiated Rate |
$1,808.25 |
| Rate for Payer: Amerigroup Medicaid |
$702.51
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$695.69
|
| Rate for Payer: Medical Associates Commercial |
$1,808.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,687.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$699.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,808.25
|
| Rate for Payer: United Healthcare Commercial |
$1,079.25
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,387.50
|
| Rate for Payer: Wellmark IA PPO |
$1,632.40
|
|
|
47564 LAP CHOLE W/ EXPLOR OF COMMON DUCT
|
Professional
|
Both
|
$3,758.00
|
|
|
Service Code
|
CPT 47564
|
| Hospital Charge Code |
8068967
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$826.25 |
| Max. Negotiated Rate |
$2,818.50 |
| Rate for Payer: Amerigroup Medicaid |
$834.35
|
| Rate for Payer: Cash Price |
$3,006.40
|
| Rate for Payer: Cash Price |
$3,006.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$826.25
|
| Rate for Payer: Medical Associates Commercial |
$2,818.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,630.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$830.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,818.50
|
| Rate for Payer: United Healthcare Commercial |
$1,678.10
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,156.60
|
| Rate for Payer: Wellmark IA PPO |
$2,537.20
|
|
|
47600 CHOLECYSTECTOMY
|
Professional
|
Both
|
$3,604.00
|
|
|
Service Code
|
CPT 47600
|
| Hospital Charge Code |
8069179
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$670.50 |
| Max. Negotiated Rate |
$2,703.00 |
| Rate for Payer: Amerigroup Medicaid |
$677.07
|
| Rate for Payer: Cash Price |
$2,883.20
|
| Rate for Payer: Cash Price |
$2,883.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$670.50
|
| Rate for Payer: Medical Associates Commercial |
$2,703.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,522.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$673.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,703.00
|
| Rate for Payer: United Healthcare Commercial |
$1,611.15
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,061.80
|
| Rate for Payer: Wellmark IA PPO |
$2,425.60
|
|
|
47605 Cholecystectomy; with cholangiography
|
Professional
|
Both
|
$3,802.00
|
|
|
Service Code
|
CPT 47605
|
| Hospital Charge Code |
8799192
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$722.39 |
| Max. Negotiated Rate |
$2,851.50 |
| Rate for Payer: Amerigroup Medicaid |
$729.48
|
| Rate for Payer: Cash Price |
$3,041.60
|
| Rate for Payer: Cash Price |
$3,041.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$722.39
|
| Rate for Payer: Medical Associates Commercial |
$2,851.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,661.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$725.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,851.50
|
| Rate for Payer: United Healthcare Commercial |
$1,694.64
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,170.70
|
| Rate for Payer: Wellmark IA PPO |
$2,553.80
|
|
|
49000 LAPAROTOMY
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
CPT 49000
|
| Hospital Charge Code |
8069048
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$666.97 |
| Max. Negotiated Rate |
$1,950.00 |
| Rate for Payer: Amerigroup Medicaid |
$673.51
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$666.97
|
| Rate for Payer: Medical Associates Commercial |
$1,950.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,820.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$670.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare Commercial |
$1,160.53
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,480.50
|
| Rate for Payer: Wellmark IA PPO |
$1,741.70
|
|
|
49320 LAPAROSCOPY DIAGNOSTIC
|
Professional
|
Both
|
$1,098.00
|
|
|
Service Code
|
CPT 49320
|
| Hospital Charge Code |
8378859
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$299.77 |
| Max. Negotiated Rate |
$823.50 |
| Rate for Payer: Amerigroup Medicaid |
$302.71
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$299.77
|
| Rate for Payer: Medical Associates Commercial |
$823.50
|
| Rate for Payer: Midlands Choice Commercial |
$768.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$301.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$823.50
|
| Rate for Payer: United Healthcare Commercial |
$495.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$637.10
|
| Rate for Payer: Wellmark IA PPO |
$749.50
|
|
|
49505 HERNIA REPR INIT INGUINAL>5YR
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
CPT 49505
|
| Hospital Charge Code |
8069140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$393.18 |
| Max. Negotiated Rate |
$1,315.50 |
| Rate for Payer: Amerigroup Medicaid |
$397.03
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$393.18
|
| Rate for Payer: Medical Associates Commercial |
$1,315.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,227.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$395.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,315.50
|
| Rate for Payer: United Healthcare Commercial |
$784.53
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.90
|
| Rate for Payer: Wellmark IA PPO |
$1,192.80
|
|
|
49507 Repair initial inguinal hernia age 5+ incarcerated/strangulated
|
Professional
|
Both
|
$1,979.00
|
|
|
Service Code
|
CPT 49507
|
| Hospital Charge Code |
8799193
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$490.73 |
| Max. Negotiated Rate |
$1,484.25 |
| Rate for Payer: Amerigroup Medicaid |
$495.54
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Cash Price |
$1,583.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$490.73
|
| Rate for Payer: Medical Associates Commercial |
$1,484.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,385.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$493.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,484.25
|
| Rate for Payer: United Healthcare Commercial |
$882.30
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,138.90
|
| Rate for Payer: Wellmark IA PPO |
$1,339.90
|
|
|
49520 HERNIA REP RECUR INGNL REDC ANY AGE
|
Professional
|
Both
|
$2,131.00
|
|
|
Service Code
|
CPT 49520
|
| Hospital Charge Code |
8069154
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$486.86 |
| Max. Negotiated Rate |
$1,598.25 |
| Rate for Payer: Amerigroup Medicaid |
$491.63
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Cash Price |
$1,704.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$486.86
|
| Rate for Payer: Medical Associates Commercial |
$1,598.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,491.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$489.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,598.25
|
| Rate for Payer: United Healthcare Commercial |
$951.22
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,226.70
|
| Rate for Payer: Wellmark IA PPO |
$1,443.20
|
|
|
49521 HERNIA REPR INIT HERNIA ANY AGE
|
Professional
|
Both
|
$2,417.00
|
|
|
Service Code
|
CPT 49521
|
| Hospital Charge Code |
8069069
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$564.67 |
| Max. Negotiated Rate |
$1,812.75 |
| Rate for Payer: Amerigroup Medicaid |
$570.21
|
| Rate for Payer: Cash Price |
$1,933.60
|
| Rate for Payer: Cash Price |
$1,933.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$564.67
|
| Rate for Payer: Medical Associates Commercial |
$1,812.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,691.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$567.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,812.75
|
| Rate for Payer: United Healthcare Commercial |
$1,079.31
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,385.60
|
| Rate for Payer: Wellmark IA PPO |
$1,630.10
|
|
