|
11403 Excision benign lesion- trunk arms legs 2.1 to 3.0 cm
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
CPT 11403
|
| Hospital Charge Code |
8799084
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$136.34 |
| Max. Negotiated Rate |
$449.40 |
| Rate for Payer: Aetna of IA Medicare |
$136.34
|
| Rate for Payer: Amerigroup Medicaid |
$140.98
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$163.61
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$139.07
|
| Rate for Payer: Medical Associates Commercial |
$259.05
|
| Rate for Payer: Medical Associates Managed Medicare |
$136.34
|
| Rate for Payer: Midlands Choice Commercial |
$449.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$235.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$204.51
|
|
|
11404 Excision benign lesion incl margins 3.1-4.0cm
|
Professional
|
Both
|
$722.00
|
|
|
Service Code
|
CPT 11404
|
| Hospital Charge Code |
8799086
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$149.37 |
| Max. Negotiated Rate |
$505.40 |
| Rate for Payer: Aetna of IA Medicare |
$149.37
|
| Rate for Payer: Amerigroup Medicaid |
$154.45
|
| Rate for Payer: Cash Price |
$577.60
|
| Rate for Payer: Cash Price |
$577.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$179.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$152.36
|
| Rate for Payer: Medical Associates Commercial |
$283.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$149.37
|
| Rate for Payer: Midlands Choice Commercial |
$505.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$258.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$224.06
|
|
|
11406 Excision benign lesion- trunk arms legs over 4.0 cm
|
Professional
|
Both
|
$1,052.00
|
|
|
Service Code
|
CPT 11406
|
| Hospital Charge Code |
8799087
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$224.09 |
| Max. Negotiated Rate |
$736.40 |
| Rate for Payer: Aetna of IA Medicare |
$224.09
|
| Rate for Payer: Amerigroup Medicaid |
$231.71
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Cash Price |
$841.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$268.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$228.57
|
| Rate for Payer: Medical Associates Commercial |
$425.77
|
| Rate for Payer: Medical Associates Managed Medicare |
$224.09
|
| Rate for Payer: Midlands Choice Commercial |
$736.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$387.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$336.14
|
|
|
11420 Excision benign lesion; scalp neck hands feet 0.5cm or less
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 11420
|
| Hospital Charge Code |
8799088
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$75.58 |
| Max. Negotiated Rate |
$294.00 |
| Rate for Payer: Aetna of IA Medicare |
$75.58
|
| Rate for Payer: Amerigroup Medicaid |
$78.15
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.09
|
| Rate for Payer: Medical Associates Commercial |
$143.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.58
|
| Rate for Payer: Midlands Choice Commercial |
$294.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$130.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.37
|
|
|
11421 Excision B9 tumor incl margins scalp neck feet - 0.6-1.0 cm
|
Professional
|
Both
|
$524.00
|
|
|
Service Code
|
CPT 11421
|
| Hospital Charge Code |
8799089
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$100.01 |
| Max. Negotiated Rate |
$366.80 |
| Rate for Payer: Aetna of IA Medicare |
$100.01
|
| Rate for Payer: Amerigroup Medicaid |
$103.41
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.01
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.01
|
| Rate for Payer: Medical Associates Commercial |
$190.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$100.01
|
| Rate for Payer: Midlands Choice Commercial |
$366.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$173.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$150.02
|
|
|
11422 Excision benign lesion scalp neck genitalia 1.1-2.0 cm
|
Professional
|
Both
|
$590.00
|
|
|
Service Code
|
CPT 11422
|
| Hospital Charge Code |
8799090
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$413.00 |
| Rate for Payer: Aetna of IA Medicare |
$124.22
|
| Rate for Payer: Amerigroup Medicaid |
$128.44
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Cash Price |
$472.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$149.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.70
|
| Rate for Payer: Medical Associates Commercial |
$236.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$124.22
|
| Rate for Payer: Midlands Choice Commercial |
$413.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$214.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$186.33
|
|
|
11423 Excision benign lesion incl margins 2.1-3.0cm
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
CPT 11423
|
| Hospital Charge Code |
8799091
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$143.54 |
| Max. Negotiated Rate |
$471.10 |
| Rate for Payer: Aetna of IA Medicare |
$143.54
|
| Rate for Payer: Amerigroup Medicaid |
$148.42
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$146.41
|
| Rate for Payer: Medical Associates Commercial |
$272.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$143.54
|
| Rate for Payer: Midlands Choice Commercial |
$471.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$248.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$215.31
|
|
|
11424 Excision benign lesion incl margins 3.1-4.0cm
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
CPT 11424
|
| Hospital Charge Code |
8799092
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$164.77 |
| Max. Negotiated Rate |
$542.50 |
| Rate for Payer: Aetna of IA Medicare |
$164.77
|
| Rate for Payer: Amerigroup Medicaid |
$170.37
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Cash Price |
$620.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$197.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$168.07
|
| Rate for Payer: Medical Associates Commercial |
$313.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$164.77
|
| Rate for Payer: Midlands Choice Commercial |
$542.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$285.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$247.16
|
|
|
11426 Excision benign lesion neck over 4 cm
|
Professional
|
Both
|
$1,115.00
|
|
|
Service Code
|
CPT 11426
|
| Hospital Charge Code |
8799093
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$243.20 |
| Max. Negotiated Rate |
$780.50 |
| Rate for Payer: Aetna of IA Medicare |
$243.20
|
| Rate for Payer: Amerigroup Medicaid |
$251.47
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Cash Price |
$892.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$291.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$248.06
|
| Rate for Payer: Medical Associates Commercial |
$462.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$243.20
|
| Rate for Payer: Midlands Choice Commercial |
$780.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$420.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$364.80
|
|
|
11443 Excision- B9 lesion: face ears eyelids nose lips 2.1-3.0 cm
|
Professional
|
Both
|
$752.00
|
|
|
Service Code
|
CPT 11443
|
| Hospital Charge Code |
8799094
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$163.32 |
| Max. Negotiated Rate |
$526.40 |
| Rate for Payer: Aetna of IA Medicare |
$163.32
|
| Rate for Payer: Amerigroup Medicaid |
$168.87
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Cash Price |
$601.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.59
|
| Rate for Payer: Medical Associates Commercial |
$310.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$163.32
|
| Rate for Payer: Midlands Choice Commercial |
$526.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$282.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$244.98
|
|
|
11603 Excision malignant lesion trunk- 2.1- 3.0 cm
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
CPT 11603
|
| Hospital Charge Code |
8799095
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$175.45 |
| Max. Negotiated Rate |
$695.10 |
| Rate for Payer: Aetna of IA Medicare |
$175.45
|
| Rate for Payer: Amerigroup Medicaid |
$181.42
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$210.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$178.96
|
| Rate for Payer: Medical Associates Commercial |
$333.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$175.45
|
| Rate for Payer: Midlands Choice Commercial |
$695.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$303.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$263.18
|
|
|
11623 Excision malignant lesion-scalp neck hands feet 2.1-3.0 cm
|
Professional
|
Both
|
$997.00
|
|
|
Service Code
|
CPT 11623
|
| Hospital Charge Code |
8799096
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$189.73 |
| Max. Negotiated Rate |
$697.90 |
| Rate for Payer: Aetna of IA Medicare |
$189.73
|
| Rate for Payer: Amerigroup Medicaid |
$196.18
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Cash Price |
$797.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$227.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$193.52
|
| Rate for Payer: Medical Associates Commercial |
$360.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$189.73
|
| Rate for Payer: Midlands Choice Commercial |
$697.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$328.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$284.60
|
|
|
11643 Excision malignant lesion-face ears eyelids nose lips- 2.1-3.0 cm
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 11643
|
| Hospital Charge Code |
8799097
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$205.86 |
| Max. Negotiated Rate |
$742.00 |
| Rate for Payer: Aetna of IA Medicare |
$205.86
|
| Rate for Payer: Amerigroup Medicaid |
$212.86
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Cash Price |
$848.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$247.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$209.98
|
| Rate for Payer: Medical Associates Commercial |
$391.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$205.86
|
| Rate for Payer: Midlands Choice Commercial |
$742.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$356.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$308.79
|
|
|
11730 Avulsion of nail plate partial or complete simple; single
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
8799098
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$256.20 |
| Rate for Payer: Aetna of IA Medicare |
$49.48
|
| Rate for Payer: Amerigroup Medicaid |
$51.16
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.47
|
| Rate for Payer: Medical Associates Commercial |
$94.01
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.48
|
| Rate for Payer: Midlands Choice Commercial |
$256.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$85.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.22
|
|
|
11770 EXC PILONID CYST SIMPLE
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
CPT 11770
|
| Hospital Charge Code |
8069078
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$166.03 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna of IA Medicare |
$166.03
|
| Rate for Payer: Amerigroup Medicaid |
$171.68
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$199.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$169.35
|
| Rate for Payer: Medical Associates Commercial |
$315.46
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.03
|
| Rate for Payer: Midlands Choice Commercial |
$728.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$287.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.04
|
|
|
11772 Excision of pilonidal cyst/sinus; complicated
|
Professional
|
Both
|
$2,444.00
|
|
|
Service Code
|
CPT 11772
|
| Hospital Charge Code |
8799099
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$519.62 |
| Max. Negotiated Rate |
$1,710.80 |
| Rate for Payer: Aetna of IA Medicare |
$519.62
|
| Rate for Payer: Amerigroup Medicaid |
$537.29
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$623.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$530.01
|
| Rate for Payer: Medical Associates Commercial |
$987.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$519.62
|
| Rate for Payer: Midlands Choice Commercial |
$1,710.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$898.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$779.43
|
|
|
12011 Simple repair/superficial wound of face ears etc 2.5cm or less
|
Professional
|
Both
|
$369.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
8799100
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$119.49 |
| Rate for Payer: Aetna of IA Medicare |
$49.54
|
| Rate for Payer: Amerigroup Medicaid |
$51.22
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.53
|
| Rate for Payer: Medical Associates Commercial |
$94.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.54
|
| Rate for Payer: Midlands Choice Commercial |
$119.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$85.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.31
|
|
|
12034 Repair intermediate wounds of scalp trunk extremities- 7.6-12.5 cm
|
Professional
|
Both
|
$1,058.00
|
|
|
Service Code
|
CPT 12034
|
| Hospital Charge Code |
8799101
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$186.35 |
| Max. Negotiated Rate |
$740.60 |
| Rate for Payer: Aetna of IA Medicare |
$186.35
|
| Rate for Payer: Amerigroup Medicaid |
$192.69
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Cash Price |
$846.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$223.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$190.08
|
| Rate for Payer: Medical Associates Commercial |
$354.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$186.35
|
| Rate for Payer: Midlands Choice Commercial |
$740.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$322.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$279.52
|
|
|
13121 Repair complex scalp arms and/or legs 2.6-7.5 cm
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
CPT 13121
|
| Hospital Charge Code |
8799102
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$233.97 |
| Max. Negotiated Rate |
$1,001.00 |
| Rate for Payer: Aetna of IA Medicare |
$233.97
|
| Rate for Payer: Amerigroup Medicaid |
$241.92
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Cash Price |
$1,144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$280.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$238.65
|
| Rate for Payer: Medical Associates Commercial |
$444.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$233.97
|
| Rate for Payer: Midlands Choice Commercial |
$1,001.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$404.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$350.96
|
|
|
13132 Repair complex forehead cheeks neck 2.6 to 7.5 cm
|
Professional
|
Both
|
$1,582.00
|
|
|
Service Code
|
CPT 13132
|
| Hospital Charge Code |
8799103
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$274.46 |
| Max. Negotiated Rate |
$638.34 |
| Rate for Payer: Aetna of IA Medicare |
$274.46
|
| Rate for Payer: Amerigroup Medicaid |
$283.79
|
| Rate for Payer: Cash Price |
$1,265.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$329.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$279.95
|
| Rate for Payer: Medical Associates Commercial |
$521.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$274.46
|
| Rate for Payer: Midlands Choice Commercial |
$638.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$474.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$411.69
|
|
|
14000 Adjacent tissue transfer/rearrangement; trunk; 10 sq cm or less
|
Professional
|
Both
|
$2,087.00
|
|
|
Service Code
|
CPT 14000
|
| Hospital Charge Code |
8799104
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$455.54 |
| Max. Negotiated Rate |
$1,460.90 |
| Rate for Payer: Aetna of IA Medicare |
$455.54
|
| Rate for Payer: Amerigroup Medicaid |
$471.03
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$546.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$464.65
|
| Rate for Payer: Medical Associates Commercial |
$865.53
|
| Rate for Payer: Medical Associates Managed Medicare |
$455.54
|
| Rate for Payer: Midlands Choice Commercial |
$1,460.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$788.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$683.31
|
|
|
14301 Adjacent tissue transfer any area 30.1 sq cm - 60 sq cm
|
Professional
|
Both
|
$3,600.00
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
8799106
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$784.20 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Aetna of IA Medicare |
$784.20
|
| Rate for Payer: Amerigroup Medicaid |
$810.86
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Cash Price |
$2,880.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$941.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$799.88
|
| Rate for Payer: Medical Associates Commercial |
$1,489.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$784.20
|
| Rate for Payer: Midlands Choice Commercial |
$2,520.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,356.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,176.30
|
|
|
15275 Application of skin substitute to face feet etc 1st 25 sq cm
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
8799107
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$85.19 |
| Max. Negotiated Rate |
$366.10 |
| Rate for Payer: Aetna of IA Medicare |
$85.19
|
| Rate for Payer: Amerigroup Medicaid |
$88.09
|
| Rate for Payer: Cash Price |
$418.40
|
| Rate for Payer: Cash Price |
$418.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.89
|
| Rate for Payer: Medical Associates Commercial |
$161.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$85.19
|
| Rate for Payer: Midlands Choice Commercial |
$366.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$127.78
|
|
|
15830 PANNICULECTOMY, EXCESSIVE SKIN/TISSUE REMOVAL
|
Professional
|
Both
|
$3,939.00
|
|
|
Service Code
|
CPT 15830
|
| Hospital Charge Code |
8068900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,050.30 |
| Max. Negotiated Rate |
$2,757.30 |
| Rate for Payer: Aetna of IA Medicare |
$1,050.30
|
| Rate for Payer: Amerigroup Medicaid |
$1,086.01
|
| Rate for Payer: Cash Price |
$3,151.20
|
| Rate for Payer: Cash Price |
$3,151.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,260.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,071.31
|
| Rate for Payer: Medical Associates Commercial |
$1,995.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,050.30
|
| Rate for Payer: Midlands Choice Commercial |
$2,757.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,817.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,575.45
|
|
|
1.6MM COMPRESSION WIRE X 150MM
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT C1763
|
| Hospital Charge Code |
8748467
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$36.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$53.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
|
