|
57550 EXCISION OF CERVICAL/VAGINAL APP
|
Professional
|
Both
|
$1,344.00
|
|
|
Service Code
|
CPT 57550
|
| Hospital Charge Code |
8378892
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$374.55 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Amerigroup Medicaid |
$378.23
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Cash Price |
$1,075.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$374.55
|
| Rate for Payer: Medical Associates Commercial |
$1,008.00
|
| Rate for Payer: Midlands Choice Commercial |
$940.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$376.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare Commercial |
$644.59
|
| Rate for Payer: Wellmark IA HMO WHPI |
$824.00
|
| Rate for Payer: Wellmark IA PPO |
$969.40
|
|
|
58100 ENDOMETRIAL BX W/O CERVICAL DILATION
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
8378877
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$271.50 |
| Rate for Payer: Amerigroup Medicaid |
$57.57
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Cash Price |
$289.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.01
|
| Rate for Payer: Medical Associates Commercial |
$271.50
|
| Rate for Payer: Midlands Choice Commercial |
$253.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$271.50
|
| Rate for Payer: United Healthcare Commercial |
$147.84
|
| Rate for Payer: Wellmark IA HMO WHPI |
$192.50
|
| Rate for Payer: Wellmark IA PPO |
$226.40
|
|
|
58120 DC DIAGNOSTIC OR TEHERAP NOT OB
|
Professional
|
Both
|
$856.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
8069166
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.13 |
| Max. Negotiated Rate |
$667.50 |
| Rate for Payer: Amerigroup Medicaid |
$231.38
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$229.13
|
| Rate for Payer: Medical Associates Commercial |
$642.00
|
| Rate for Payer: Midlands Choice Commercial |
$599.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$230.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$642.00
|
| Rate for Payer: United Healthcare Commercial |
$426.83
|
| Rate for Payer: Wellmark IA HMO WHPI |
$567.40
|
| Rate for Payer: Wellmark IA PPO |
$667.50
|
|
|
58150 TOTAL ABDOMINAL HYSTERECTOMY
|
Professional
|
Both
|
$3,384.00
|
|
|
Service Code
|
CPT 58150
|
| Hospital Charge Code |
8378894
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$861.22 |
| Max. Negotiated Rate |
$2,538.00 |
| Rate for Payer: Amerigroup Medicaid |
$869.66
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Cash Price |
$2,707.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$861.22
|
| Rate for Payer: Medical Associates Commercial |
$2,538.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,368.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$865.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,538.00
|
| Rate for Payer: United Healthcare Commercial |
$1,548.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,926.00
|
| Rate for Payer: Wellmark IA PPO |
$2,265.90
|
|
|
58180 SUPRACERVICAL ABD HYSTERECTOMY
|
Professional
|
Both
|
$2,961.00
|
|
|
Service Code
|
CPT 58180
|
| Hospital Charge Code |
8378895
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$867.23 |
| Max. Negotiated Rate |
$2,220.75 |
| Rate for Payer: Amerigroup Medicaid |
$875.74
|
| Rate for Payer: Cash Price |
$2,368.80
|
| Rate for Payer: Cash Price |
$2,368.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$867.23
|
| Rate for Payer: Medical Associates Commercial |
$2,220.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,072.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$871.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,220.75
|
| Rate for Payer: United Healthcare Commercial |
$1,474.42
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,821.60
|
| Rate for Payer: Wellmark IA PPO |
$2,143.00
|
|
|
58262 VAG HYS <250G W/REMOVAL T/O
|
Professional
|
Both
|
$3,054.00
|
|
|
Service Code
|
CPT 58262
|
| Hospital Charge Code |
8378899
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$796.41 |
| Max. Negotiated Rate |
$2,290.50 |
| Rate for Payer: Amerigroup Medicaid |
$804.21
|
| Rate for Payer: Cash Price |
$2,443.20
|
| Rate for Payer: Cash Price |
$2,443.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$796.41
|
| Rate for Payer: Medical Associates Commercial |
$2,290.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,137.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$800.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,290.50
|
| Rate for Payer: United Healthcare Commercial |
$1,423.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,758.70
|
| Rate for Payer: Wellmark IA PPO |
$2,069.00
|
|
|
58291 VAG HYST > 250G W/ REMOVAL T/O
|
Professional
|
Both
|
$4,112.00
|
|
|
Service Code
|
CPT 58291
|
| Hospital Charge Code |
8378900
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$796.41 |
| Max. Negotiated Rate |
$3,084.00 |
| Rate for Payer: Amerigroup Medicaid |
$804.21
|
| Rate for Payer: Cash Price |
$3,289.60
|
| Rate for Payer: Cash Price |
$3,289.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$796.41
|
| Rate for Payer: Medical Associates Commercial |
$3,084.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,878.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$800.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,084.00
|
| Rate for Payer: United Healthcare Commercial |
$1,922.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,353.10
|
| Rate for Payer: Wellmark IA PPO |
$2,768.30
|
|
|
58300 IUD INSERTION
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
8069024
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$73.76 |
| Max. Negotiated Rate |
$244.90 |
| Rate for Payer: Amerigroup Medicaid |
$74.48
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.76
|
| Rate for Payer: Medical Associates Commercial |
$180.00
|
| Rate for Payer: Midlands Choice Commercial |
$168.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$180.00
|
| Rate for Payer: United Healthcare Commercial |
$139.09
|
| Rate for Payer: Wellmark IA HMO WHPI |
$208.20
|
| Rate for Payer: Wellmark IA PPO |
$244.90
|
|
|
58340 Catheterization/introduction of saline/contrast during hysterosalpingography
|
Professional
|
Both
|
$645.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
8799201
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$199.39 |
| Max. Negotiated Rate |
$537.20 |
| Rate for Payer: Amerigroup Medicaid |
$201.34
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Cash Price |
$516.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$199.39
|
| Rate for Payer: Medical Associates Commercial |
$483.75
|
| Rate for Payer: Midlands Choice Commercial |
$451.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$200.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$483.75
|
| Rate for Payer: United Healthcare Commercial |
$291.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$456.70
|
| Rate for Payer: Wellmark IA PPO |
$537.20
|
|
|
58350 Chromotubation of oviduct
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
CPT 58350
|
| Hospital Charge Code |
8799202
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$79.36 |
| Max. Negotiated Rate |
$344.10 |
| Rate for Payer: Amerigroup Medicaid |
$80.13
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.36
|
| Rate for Payer: Medical Associates Commercial |
$316.50
|
| Rate for Payer: Midlands Choice Commercial |
$295.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$316.50
|
| Rate for Payer: United Healthcare Commercial |
$190.82
|
| Rate for Payer: Wellmark IA HMO WHPI |
$292.50
|
| Rate for Payer: Wellmark IA PPO |
$344.10
|
|
|
58541 LAP SUPRACERVICAL HYST <250G
|
Professional
|
Both
|
$2,376.00
|
|
|
Service Code
|
CPT 58541
|
| Hospital Charge Code |
8378896
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$665.45 |
| Max. Negotiated Rate |
$1,782.00 |
| Rate for Payer: Amerigroup Medicaid |
$671.97
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Cash Price |
$1,900.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$665.45
|
| Rate for Payer: Medical Associates Commercial |
$1,782.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,663.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$668.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,782.00
|
| Rate for Payer: United Healthcare Commercial |
$1,117.10
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,386.30
|
| Rate for Payer: Wellmark IA PPO |
$1,631.00
|
|
|
58542 LAP SUPRACERVICAL HIST <250G T/O
|
Professional
|
Both
|
$2,714.00
|
|
|
Service Code
|
CPT 58542
|
| Hospital Charge Code |
8378897
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$807.13 |
| Max. Negotiated Rate |
$2,035.50 |
| Rate for Payer: Amerigroup Medicaid |
$815.04
|
| Rate for Payer: Cash Price |
$2,171.20
|
| Rate for Payer: Cash Price |
$2,171.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$807.13
|
| Rate for Payer: Medical Associates Commercial |
$2,035.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,899.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$811.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,035.50
|
| Rate for Payer: United Healthcare Commercial |
$1,270.91
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,573.80
|
| Rate for Payer: Wellmark IA PPO |
$1,851.50
|
|
|
58544 LAP SUPRACERVICAL HYST >250G
|
Professional
|
Both
|
$2,989.00
|
|
|
Service Code
|
CPT 58544
|
| Hospital Charge Code |
8378898
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$888.80 |
| Max. Negotiated Rate |
$2,241.75 |
| Rate for Payer: Amerigroup Medicaid |
$897.51
|
| Rate for Payer: Cash Price |
$2,391.20
|
| Rate for Payer: Cash Price |
$2,391.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$888.80
|
| Rate for Payer: Medical Associates Commercial |
$2,241.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,092.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$893.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,241.75
|
| Rate for Payer: United Healthcare Commercial |
$1,389.74
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,717.20
|
| Rate for Payer: Wellmark IA PPO |
$2,020.20
|
|
|
58552 LAVH <250G W/REMOVAL T/O
|
Professional
|
Both
|
$3,279.00
|
|
|
Service Code
|
CPT 58552
|
| Hospital Charge Code |
8378901
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$765.02 |
| Max. Negotiated Rate |
$2,459.25 |
| Rate for Payer: Amerigroup Medicaid |
$772.52
|
| Rate for Payer: Cash Price |
$2,623.20
|
| Rate for Payer: Cash Price |
$2,623.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$765.02
|
| Rate for Payer: Medical Associates Commercial |
$2,459.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,295.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$768.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,459.25
|
| Rate for Payer: United Healthcare Commercial |
$1,510.03
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,858.10
|
| Rate for Payer: Wellmark IA PPO |
$2,186.00
|
|
|
58554 LAVH >250G W/REMOVAL T/O
|
Professional
|
Both
|
$4,407.00
|
|
|
Service Code
|
CPT 58554
|
| Hospital Charge Code |
8378902
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$981.83 |
| Max. Negotiated Rate |
$3,305.25 |
| Rate for Payer: Amerigroup Medicaid |
$991.46
|
| Rate for Payer: Cash Price |
$3,525.60
|
| Rate for Payer: Cash Price |
$3,525.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$981.83
|
| Rate for Payer: Medical Associates Commercial |
$3,305.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,084.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$986.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,305.25
|
| Rate for Payer: United Healthcare Commercial |
$2,019.57
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,469.50
|
| Rate for Payer: Wellmark IA PPO |
$2,905.20
|
|
|
58555 HYSTEROSCOPY; DIAGNOSTIC
|
Professional
|
Both
|
$887.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
8378879
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$276.76 |
| Max. Negotiated Rate |
$802.20 |
| Rate for Payer: Amerigroup Medicaid |
$279.47
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Cash Price |
$709.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$276.76
|
| Rate for Payer: Medical Associates Commercial |
$665.25
|
| Rate for Payer: Midlands Choice Commercial |
$620.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$278.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$665.25
|
| Rate for Payer: United Healthcare Commercial |
$487.49
|
| Rate for Payer: Wellmark IA HMO WHPI |
$681.80
|
| Rate for Payer: Wellmark IA PPO |
$802.20
|
|
|
58559 HYSTEROSCOPY W/LYSIS OF ADHESION
|
Professional
|
Both
|
$966.00
|
|
|
Service Code
|
CPT 58559
|
| Hospital Charge Code |
8378881
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$317.43 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Amerigroup Medicaid |
$320.55
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Cash Price |
$772.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$317.43
|
| Rate for Payer: Medical Associates Commercial |
$724.50
|
| Rate for Payer: Midlands Choice Commercial |
$676.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$318.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$724.50
|
| Rate for Payer: United Healthcare Commercial |
$441.60
|
| Rate for Payer: Wellmark IA HMO WHPI |
$534.00
|
| Rate for Payer: Wellmark IA PPO |
$628.30
|
|
|
58561 Hysteroscopy surgical; w/ removal of leiomyomata
|
Professional
|
Both
|
$1,201.00
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
8799203
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$508.38 |
| Max. Negotiated Rate |
$900.75 |
| Rate for Payer: Amerigroup Medicaid |
$513.36
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$508.38
|
| Rate for Payer: Medical Associates Commercial |
$900.75
|
| Rate for Payer: Midlands Choice Commercial |
$840.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$510.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$900.75
|
| Rate for Payer: United Healthcare Commercial |
$555.31
|
| Rate for Payer: Wellmark IA HMO WHPI |
$673.00
|
| Rate for Payer: Wellmark IA PPO |
$791.80
|
|
|
58563 HSC W/ENDOMETRIAL ABLATION
|
Professional
|
Both
|
$5,245.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
8378882
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,487.73 |
| Max. Negotiated Rate |
$4,636.80 |
| Rate for Payer: Amerigroup Medicaid |
$1,502.32
|
| Rate for Payer: Cash Price |
$4,196.00
|
| Rate for Payer: Cash Price |
$4,196.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,487.73
|
| Rate for Payer: Medical Associates Commercial |
$3,933.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,671.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,495.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,933.75
|
| Rate for Payer: United Healthcare Commercial |
$2,917.52
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,941.30
|
| Rate for Payer: Wellmark IA PPO |
$4,636.80
|
|
|
58565 HSC W/BILAT/FALLOPIAN TUBE
|
Professional
|
Both
|
$6,201.00
|
|
|
Service Code
|
CPT 58565
|
| Hospital Charge Code |
8378883
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,673.22 |
| Max. Negotiated Rate |
$4,650.75 |
| Rate for Payer: Amerigroup Medicaid |
$1,689.62
|
| Rate for Payer: Cash Price |
$4,960.80
|
| Rate for Payer: Cash Price |
$4,960.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,673.22
|
| Rate for Payer: Medical Associates Commercial |
$4,650.75
|
| Rate for Payer: Midlands Choice Commercial |
$4,340.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,681.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,650.75
|
| Rate for Payer: United Healthcare Commercial |
$2,711.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,126.80
|
| Rate for Payer: Wellmark IA PPO |
$3,678.50
|
|
|
58570 LAP TOTAL HYST FOR UTERUS <250G
|
Professional
|
Both
|
$2,587.00
|
|
|
Service Code
|
CPT 58570
|
| Hospital Charge Code |
8378903
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$690.27 |
| Max. Negotiated Rate |
$1,940.25 |
| Rate for Payer: Amerigroup Medicaid |
$697.04
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Cash Price |
$2,069.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$690.27
|
| Rate for Payer: Medical Associates Commercial |
$1,940.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,810.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$693.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,940.25
|
| Rate for Payer: United Healthcare Commercial |
$1,217.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,532.20
|
| Rate for Payer: Wellmark IA PPO |
$1,802.60
|
|
|
58571 LAP TOTAL HYST W/REMOVAL TUBES AND/OR OVERIES
|
Professional
|
Both
|
$2,991.00
|
|
|
Service Code
|
CPT 58571
|
| Hospital Charge Code |
8378904
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$756.91 |
| Max. Negotiated Rate |
$2,243.25 |
| Rate for Payer: Amerigroup Medicaid |
$764.33
|
| Rate for Payer: Cash Price |
$2,392.80
|
| Rate for Payer: Cash Price |
$2,392.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$756.91
|
| Rate for Payer: Medical Associates Commercial |
$2,243.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,093.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$760.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,243.25
|
| Rate for Payer: United Healthcare Commercial |
$1,373.06
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,725.30
|
| Rate for Payer: Wellmark IA PPO |
$2,029.80
|
|
|
58600 TUBAL LIGATION
|
Professional
|
Both
|
$1,201.00
|
|
|
Service Code
|
CPT 58600
|
| Hospital Charge Code |
8068988
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$259.88 |
| Max. Negotiated Rate |
$900.75 |
| Rate for Payer: Amerigroup Medicaid |
$262.42
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Cash Price |
$960.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$259.88
|
| Rate for Payer: Medical Associates Commercial |
$900.75
|
| Rate for Payer: Midlands Choice Commercial |
$840.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$261.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$900.75
|
| Rate for Payer: United Healthcare Commercial |
$564.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$706.40
|
| Rate for Payer: Wellmark IA PPO |
$831.00
|
|
|
58605 TUBAL LIGATION POST PARTUM
|
Professional
|
Both
|
$1,088.00
|
|
|
Service Code
|
CPT 58605
|
| Hospital Charge Code |
8068982
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$816.00 |
| Rate for Payer: Amerigroup Medicaid |
$232.15
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Cash Price |
$870.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$229.90
|
| Rate for Payer: Medical Associates Commercial |
$816.00
|
| Rate for Payer: Midlands Choice Commercial |
$761.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$231.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$816.00
|
| Rate for Payer: United Healthcare Commercial |
$510.88
|
| Rate for Payer: Wellmark IA HMO WHPI |
$642.20
|
| Rate for Payer: Wellmark IA PPO |
$755.50
|
|
|
58611 TUBAL LIGATION W/OTHER PROC
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 58611
|
| Hospital Charge Code |
8069138
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$118.42 |
| Max. Negotiated Rate |
$238.84 |
| Rate for Payer: Amerigroup Medicaid |
$238.84
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$236.52
|
| Rate for Payer: Medical Associates Commercial |
$191.25
|
| Rate for Payer: Midlands Choice Commercial |
$178.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$237.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$191.25
|
| Rate for Payer: United Healthcare Commercial |
$118.42
|
| Rate for Payer: Wellmark IA HMO WHPI |
$141.50
|
| Rate for Payer: Wellmark IA PPO |
$166.50
|
|
