|
Remote Group Therapy
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS C7903
|
| Hospital Charge Code |
8300866
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Aetna of IA Medicare |
$125.97
|
| Rate for Payer: Amerigroup Medicaid |
$127.47
|
| Rate for Payer: Amerigroup Medicare |
$100.44
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.24
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.45
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.37
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$148.18
|
| Rate for Payer: Wellmark IA PPO |
$163.23
|
|
|
Remote Treatment of a Mental Health Disorder 15-29 min
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
HCPCS C7900
|
| Hospital Charge Code |
8945619
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$89.33 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Aetna of IA Commercial |
$298.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$298.80
|
| Rate for Payer: Aetna of IA Medicare |
$189.24
|
| Rate for Payer: Amerigroup Medicaid |
$191.50
|
| Rate for Payer: Amerigroup Medicare |
$150.89
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$149.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$189.64
|
| Rate for Payer: Medical Associates Commercial |
$249.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$149.40
|
| Rate for Payer: Midlands Choice Commercial |
$232.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$192.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$171.81
|
| Rate for Payer: United Healthcare Commercial |
$298.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$89.33
|
| Rate for Payer: Wellmark IA PPO |
$98.41
|
|
|
Remote Treatment of a Mental Health Disorder 15-29 min
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
HCPCS C7900
|
| Hospital Charge Code |
8945619
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Aetna of IA Commercial |
$298.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$298.80
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.00
|
| Rate for Payer: Medical Associates Commercial |
$249.00
|
| Rate for Payer: Midlands Choice Commercial |
$232.40
|
| Rate for Payer: United Healthcare Commercial |
$298.80
|
|
|
Remote Treatment of a Mental Health Disorder 30-60 min
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
HCPCS C7901
|
| Hospital Charge Code |
8945620
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$231.70 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna of IA Commercial |
$297.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$297.90
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$248.25
|
| Rate for Payer: Medical Associates Commercial |
$248.25
|
| Rate for Payer: Midlands Choice Commercial |
$231.70
|
| Rate for Payer: United Healthcare Commercial |
$297.90
|
|
|
Remote Treatment of a Mental Health Disorder 30-60 min
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
HCPCS C7901
|
| Hospital Charge Code |
8945620
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$89.33 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Aetna of IA Commercial |
$297.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$297.90
|
| Rate for Payer: Aetna of IA Medicare |
$188.67
|
| Rate for Payer: Amerigroup Medicaid |
$190.92
|
| Rate for Payer: Amerigroup Medicare |
$150.44
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$248.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$189.07
|
| Rate for Payer: Medical Associates Commercial |
$248.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.95
|
| Rate for Payer: Midlands Choice Commercial |
$231.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$191.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$171.29
|
| Rate for Payer: United Healthcare Commercial |
$297.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$89.33
|
| Rate for Payer: Wellmark IA PPO |
$98.41
|
|
|
Remote Treatment of a Mental Health Disorder ADDTL 15 min
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS C7902
|
| Hospital Charge Code |
8300865
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Aetna of IA Medicare |
$125.97
|
| Rate for Payer: Amerigroup Medicaid |
$127.47
|
| Rate for Payer: Amerigroup Medicare |
$100.44
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.24
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.45
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.37
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
|
|
Remote Treatment of a Mental Health Disorder ADDTL 15 min
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS C7902
|
| Hospital Charge Code |
8300865
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
|
|
REMOVAL FOREIGN BODY FOOT SUBQ
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
8825540
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$651.00 |
| Rate for Payer: Amerigroup Medicaid |
$166.98
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Cash Price |
$694.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$165.36
|
| Rate for Payer: Medical Associates Commercial |
$651.00
|
| Rate for Payer: Midlands Choice Commercial |
$607.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$166.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$651.00
|
| Rate for Payer: United Healthcare Commercial |
$385.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$454.10
|
| Rate for Payer: Wellmark IA PPO |
$534.30
|
|
|
REMOVAL OF ANAL FISSURE
|
Facility
|
IP
|
$1,894.00
|
|
|
Service Code
|
CPT 46200
|
| Hospital Charge Code |
7982946
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,325.80 |
| Max. Negotiated Rate |
$1,704.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,704.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,704.60
|
| Rate for Payer: Cash Price |
$1,515.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,420.50
|
| Rate for Payer: Medical Associates Commercial |
$1,420.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,325.80
|
| Rate for Payer: United Healthcare Commercial |
$1,704.60
|
|
|
REMOVAL OF ANAL FISSURE
|
Facility
|
OP
|
$1,894.00
|
|
|
Service Code
|
CPT 46200
|
| Hospital Charge Code |
7982946
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$852.30 |
| Max. Negotiated Rate |
$4,161.95 |
| Rate for Payer: Aetna of IA Commercial |
$1,704.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,704.60
|
| Rate for Payer: Aetna of IA Medicare |
$1,079.58
|
| Rate for Payer: Amerigroup Medicaid |
$1,092.46
|
| Rate for Payer: Amerigroup Medicare |
$860.82
|
| Rate for Payer: Cash Price |
$1,515.20
|
| Rate for Payer: Cash Price |
$1,515.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,420.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$852.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,081.85
|
| Rate for Payer: Medical Associates Commercial |
$1,420.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$852.30
|
| Rate for Payer: Midlands Choice Commercial |
$1,325.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,097.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$980.14
|
| Rate for Payer: United Healthcare Commercial |
$1,704.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,117.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,778.26
|
| Rate for Payer: Wellmark IA PPO |
$4,161.95
|
|
|
REMOVAL OF BREAST LESION
|
Facility
|
IP
|
$1,624.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
7982978
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,136.80 |
| Max. Negotiated Rate |
$1,461.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,461.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,218.00
|
| Rate for Payer: Medical Associates Commercial |
$1,218.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,136.80
|
| Rate for Payer: United Healthcare Commercial |
$1,461.60
|
|
|
REMOVAL OF BREAST LESION
|
Facility
|
OP
|
$1,624.00
|
|
|
Service Code
|
CPT 19120
|
| Hospital Charge Code |
7982978
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$730.80 |
| Max. Negotiated Rate |
$2,997.48 |
| Rate for Payer: Aetna of IA Commercial |
$1,461.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,461.60
|
| Rate for Payer: Aetna of IA Medicare |
$925.68
|
| Rate for Payer: Amerigroup Medicaid |
$936.72
|
| Rate for Payer: Amerigroup Medicare |
$738.11
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,218.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$730.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$927.63
|
| Rate for Payer: Medical Associates Commercial |
$1,218.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$730.80
|
| Rate for Payer: Midlands Choice Commercial |
$1,136.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$941.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$840.42
|
| Rate for Payer: United Healthcare Commercial |
$1,461.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$958.16
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,721.14
|
| Rate for Payer: Wellmark IA PPO |
$2,997.48
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
4864831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$903.62 |
| Rate for Payer: Aetna of IA Commercial |
$586.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.80
|
| Rate for Payer: Aetna of IA Medicare |
$371.64
|
| Rate for Payer: Amerigroup Medicaid |
$376.07
|
| Rate for Payer: Amerigroup Medicare |
$296.33
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$489.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$293.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$372.42
|
| Rate for Payer: Medical Associates Commercial |
$489.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$293.40
|
| Rate for Payer: Midlands Choice Commercial |
$456.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$377.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$337.41
|
| Rate for Payer: United Healthcare Commercial |
$586.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$384.68
|
| Rate for Payer: Wellmark IA HMO WHPI |
$820.31
|
| Rate for Payer: Wellmark IA PPO |
$903.62
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
4864831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Aetna of IA Commercial |
$586.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.80
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$489.00
|
| Rate for Payer: Medical Associates Commercial |
$489.00
|
| Rate for Payer: Midlands Choice Commercial |
$456.40
|
| Rate for Payer: United Healthcare Commercial |
$586.80
|
|
|
REMOVAL OF FOOT FOREIGN BODY
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
7982793
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$165.36 |
| Max. Negotiated Rate |
$648.75 |
| Rate for Payer: Amerigroup Medicaid |
$166.98
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$165.36
|
| Rate for Payer: Medical Associates Commercial |
$648.75
|
| Rate for Payer: Midlands Choice Commercial |
$605.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$166.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$648.75
|
| Rate for Payer: United Healthcare Commercial |
$385.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$454.10
|
| Rate for Payer: Wellmark IA PPO |
$534.30
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$1,696.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
7982919
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$763.20 |
| Max. Negotiated Rate |
$4,029.18 |
| Rate for Payer: Aetna of IA Commercial |
$1,526.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,526.40
|
| Rate for Payer: Aetna of IA Medicare |
$966.72
|
| Rate for Payer: Amerigroup Medicaid |
$978.25
|
| Rate for Payer: Amerigroup Medicare |
$770.83
|
| Rate for Payer: Cash Price |
$1,356.80
|
| Rate for Payer: Cash Price |
$1,356.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,272.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$763.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$968.76
|
| Rate for Payer: Medical Associates Commercial |
$1,272.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$763.20
|
| Rate for Payer: Midlands Choice Commercial |
$1,187.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$983.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$877.68
|
| Rate for Payer: United Healthcare Commercial |
$1,526.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,000.64
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,657.73
|
| Rate for Payer: Wellmark IA PPO |
$4,029.18
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$1,696.00
|
|
|
Service Code
|
CPT 27372
|
| Hospital Charge Code |
7982919
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,187.20 |
| Max. Negotiated Rate |
$1,526.40 |
| Rate for Payer: Aetna of IA Commercial |
$1,526.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,526.40
|
| Rate for Payer: Cash Price |
$1,356.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,272.00
|
| Rate for Payer: Medical Associates Commercial |
$1,272.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,187.20
|
| Rate for Payer: United Healthcare Commercial |
$1,526.40
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
4864793
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$4,029.18 |
| Rate for Payer: Aetna of IA Commercial |
$586.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.80
|
| Rate for Payer: Aetna of IA Medicare |
$371.64
|
| Rate for Payer: Amerigroup Medicaid |
$376.07
|
| Rate for Payer: Amerigroup Medicare |
$296.33
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$489.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$293.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$372.42
|
| Rate for Payer: Medical Associates Commercial |
$489.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$293.40
|
| Rate for Payer: Midlands Choice Commercial |
$456.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$377.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$337.41
|
| Rate for Payer: United Healthcare Commercial |
$586.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$384.68
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,657.73
|
| Rate for Payer: Wellmark IA PPO |
$4,029.18
|
|
|
REMOVAL OF FOREIGN BODY
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 20525
|
| Hospital Charge Code |
4864793
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Aetna of IA Commercial |
$586.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.80
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$489.00
|
| Rate for Payer: Medical Associates Commercial |
$489.00
|
| Rate for Payer: Midlands Choice Commercial |
$456.40
|
| Rate for Payer: United Healthcare Commercial |
$586.80
|
|
|
REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,969.50
|
|
|
Service Code
|
CPT 20670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,511.37 |
| Max. Negotiated Rate |
$4,969.50 |
| Rate for Payer: Wellmark IA HMO WHPI |
$4,511.37
|
| Rate for Payer: Wellmark IA PPO |
$4,969.50
|
|
|
REMOVAL OF KNEE CYST
|
Facility
|
IP
|
$1,985.00
|
|
|
Service Code
|
CPT 27345
|
| Hospital Charge Code |
7982951
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,389.50 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,786.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,786.50
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,488.75
|
| Rate for Payer: Medical Associates Commercial |
$1,488.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,389.50
|
| Rate for Payer: United Healthcare Commercial |
$1,786.50
|
|
|
REMOVAL OF KNEE CYST
|
Facility
|
OP
|
$1,985.00
|
|
|
Service Code
|
CPT 27345
|
| Hospital Charge Code |
7982951
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$893.25 |
| Max. Negotiated Rate |
$7,382.01 |
| Rate for Payer: Aetna of IA Commercial |
$1,786.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,786.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,131.45
|
| Rate for Payer: Amerigroup Medicaid |
$1,144.95
|
| Rate for Payer: Amerigroup Medicare |
$902.18
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Cash Price |
$1,588.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,488.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$893.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,133.83
|
| Rate for Payer: Medical Associates Commercial |
$1,488.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$893.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,389.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,150.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,027.24
|
| Rate for Payer: United Healthcare Commercial |
$1,786.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,171.15
|
| Rate for Payer: Wellmark IA HMO WHPI |
$6,701.47
|
| Rate for Payer: Wellmark IA PPO |
$7,382.01
|
|
|
REMOVAL OF NAIL BED
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
7982847
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$131.03 |
| Max. Negotiated Rate |
$346.10 |
| Rate for Payer: Amerigroup Medicaid |
$132.31
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$131.03
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$262.50
|
| Rate for Payer: United Healthcare Commercial |
$238.19
|
| Rate for Payer: Wellmark IA HMO WHPI |
$294.20
|
| Rate for Payer: Wellmark IA PPO |
$346.10
|
|
|
REMOVAL OF NAIL BED
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
4863317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
|
|
REMOVAL OF NAIL BED
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 11750
|
| Hospital Charge Code |
4863317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$366.75 |
| Max. Negotiated Rate |
$903.62 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Aetna of IA Medicare |
$464.55
|
| Rate for Payer: Amerigroup Medicaid |
$470.09
|
| Rate for Payer: Amerigroup Medicare |
$370.42
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$366.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$465.53
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$366.75
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$472.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$421.76
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$480.85
|
| Rate for Payer: Wellmark IA HMO WHPI |
$820.31
|
| Rate for Payer: Wellmark IA PPO |
$903.62
|
|
