|
REMOVAL OF NAIL PLATE
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
7982849
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$61.71 |
| Max. Negotiated Rate |
$247.40 |
| Rate for Payer: Amerigroup Medicaid |
$62.32
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.71
|
| Rate for Payer: Medical Associates Commercial |
$202.50
|
| Rate for Payer: Midlands Choice Commercial |
$189.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$202.50
|
| Rate for Payer: United Healthcare Commercial |
$167.58
|
| Rate for Payer: Wellmark IA HMO WHPI |
$210.30
|
| Rate for Payer: Wellmark IA PPO |
$247.40
|
|
|
REMOVAL OF NAIL PLATE
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
4863312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.30 |
| Max. Negotiated Rate |
$487.34 |
| Rate for Payer: Aetna of IA Commercial |
$246.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$246.60
|
| Rate for Payer: Aetna of IA Medicare |
$156.18
|
| Rate for Payer: Amerigroup Medicaid |
$158.04
|
| Rate for Payer: Amerigroup Medicare |
$124.53
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$205.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$123.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$156.51
|
| Rate for Payer: Medical Associates Commercial |
$205.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$123.30
|
| Rate for Payer: Midlands Choice Commercial |
$191.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$158.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.80
|
| Rate for Payer: United Healthcare Commercial |
$246.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$161.66
|
| Rate for Payer: Wellmark IA HMO WHPI |
$442.42
|
| Rate for Payer: Wellmark IA PPO |
$487.34
|
|
|
REMOVAL OF NAIL PLATE
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
4863312
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Aetna of IA Commercial |
$246.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$246.60
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$205.50
|
| Rate for Payer: Medical Associates Commercial |
$205.50
|
| Rate for Payer: Midlands Choice Commercial |
$191.80
|
| Rate for Payer: United Healthcare Commercial |
$246.60
|
|
|
REMOVAL OF SKIN TAGS <W/15
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
4862815
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.75 |
| Max. Negotiated Rate |
$333.49 |
| Rate for Payer: Aetna of IA Commercial |
$247.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$247.50
|
| Rate for Payer: Aetna of IA Medicare |
$156.75
|
| Rate for Payer: Amerigroup Medicaid |
$158.62
|
| Rate for Payer: Amerigroup Medicare |
$124.99
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$206.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$123.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.08
|
| Rate for Payer: Medical Associates Commercial |
$206.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$123.75
|
| Rate for Payer: Midlands Choice Commercial |
$192.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$142.31
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$162.25
|
| Rate for Payer: Wellmark IA HMO WHPI |
$302.74
|
| Rate for Payer: Wellmark IA PPO |
$333.49
|
|
|
REMOVAL OF SKIN TAGS <W/15
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 11200
|
| Hospital Charge Code |
4862815
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.50 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna of IA Commercial |
$247.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$247.50
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$206.25
|
| Rate for Payer: Medical Associates Commercial |
$206.25
|
| Rate for Payer: Midlands Choice Commercial |
$192.50
|
| Rate for Payer: United Healthcare Commercial |
$247.50
|
|
|
REMOVAL OF TOTAL OR NEAR TOTAL NON-INFECTED MESH OR OTHER PROSTHESIS AT THE TIME OF INITIAL OR RECURRENT ANTERIOR ABDOMINAL HERNIA REPAIR OR PARASTOMAL HERNIA REPAIR, ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$9,789.05
|
|
|
Service Code
|
CPT 49623
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,886.61 |
| Max. Negotiated Rate |
$9,789.05 |
| Rate for Payer: Wellmark IA HMO WHPI |
$8,886.61
|
| Rate for Payer: Wellmark IA PPO |
$9,789.05
|
|
|
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL
|
Facility
|
OP
|
$1,565.12
|
|
|
Service Code
|
CPT 67005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,420.84 |
| Max. Negotiated Rate |
$1,565.12 |
| Rate for Payer: Wellmark IA HMO WHPI |
$1,420.84
|
| Rate for Payer: Wellmark IA PPO |
$1,565.12
|
|
|
REMOVAL/REVISION OF CAST
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
7982784
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$39.51 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Amerigroup Medicaid |
$39.90
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39.51
|
| Rate for Payer: Medical Associates Commercial |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$147.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$157.50
|
| Rate for Payer: United Healthcare Commercial |
$93.78
|
| Rate for Payer: Wellmark IA HMO WHPI |
$122.70
|
| Rate for Payer: Wellmark IA PPO |
$144.30
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$247.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
7982918
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.15 |
| Max. Negotiated Rate |
$499.84 |
| Rate for Payer: Aetna of IA Commercial |
$222.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$222.30
|
| Rate for Payer: Aetna of IA Medicare |
$140.79
|
| Rate for Payer: Amerigroup Medicaid |
$142.47
|
| Rate for Payer: Amerigroup Medicare |
$112.26
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$185.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$111.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$141.09
|
| Rate for Payer: Medical Associates Commercial |
$185.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$111.15
|
| Rate for Payer: Midlands Choice Commercial |
$172.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$143.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$127.82
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$145.73
|
| Rate for Payer: Wellmark IA HMO WHPI |
$453.76
|
| Rate for Payer: Wellmark IA PPO |
$499.84
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
4864898
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$88.65 |
| Max. Negotiated Rate |
$499.84 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Aetna of IA Medicare |
$112.29
|
| Rate for Payer: Amerigroup Medicaid |
$113.63
|
| Rate for Payer: Amerigroup Medicare |
$89.54
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$112.53
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.65
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.95
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.23
|
| Rate for Payer: Wellmark IA HMO WHPI |
$453.76
|
| Rate for Payer: Wellmark IA PPO |
$499.84
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 29700
|
| Hospital Charge Code |
4864898
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.90 |
| Max. Negotiated Rate |
$177.30 |
| Rate for Payer: Aetna of IA Commercial |
$177.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$177.30
|
| Rate for Payer: Cash Price |
$157.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.75
|
| Rate for Payer: Medical Associates Commercial |
$147.75
|
| Rate for Payer: Midlands Choice Commercial |
$137.90
|
| Rate for Payer: United Healthcare Commercial |
$177.30
|
|
|
REMOVAL/REVISION OF CAST
|
Facility
|
IP
|
$247.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
7982918
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$172.90 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna of IA Commercial |
$222.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$222.30
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$185.25
|
| Rate for Payer: Medical Associates Commercial |
$185.25
|
| Rate for Payer: Midlands Choice Commercial |
$172.90
|
| Rate for Payer: United Healthcare Commercial |
$222.30
|
|
|
REMOVAL TNL CV CATH CHARGE
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
8068937
|
|
Hospital Revenue Code
|
987
|
| Min. Negotiated Rate |
$149.44 |
| Max. Negotiated Rate |
$375.60 |
| Rate for Payer: Amerigroup Medicaid |
$150.91
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$149.44
|
| Rate for Payer: Medical Associates Commercial |
$348.75
|
| Rate for Payer: Midlands Choice Commercial |
$325.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$348.75
|
| Rate for Payer: United Healthcare Commercial |
$252.61
|
| Rate for Payer: Wellmark IA HMO WHPI |
$319.30
|
| Rate for Payer: Wellmark IA PPO |
$375.60
|
|
|
REMOVE EYELID LESION(S)
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 67808
|
| Hospital Charge Code |
7982979
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$312.30 |
| Max. Negotiated Rate |
$2,763.18 |
| Rate for Payer: Aetna of IA Commercial |
$624.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$624.60
|
| Rate for Payer: Aetna of IA Medicare |
$395.58
|
| Rate for Payer: Amerigroup Medicaid |
$400.30
|
| Rate for Payer: Amerigroup Medicare |
$315.42
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$520.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$312.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$396.41
|
| Rate for Payer: Medical Associates Commercial |
$520.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$312.30
|
| Rate for Payer: Midlands Choice Commercial |
$485.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$402.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$359.14
|
| Rate for Payer: United Healthcare Commercial |
$624.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$409.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,508.44
|
| Rate for Payer: Wellmark IA PPO |
$2,763.18
|
|
|
REMOVE EYELID LESION(S)
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 67808
|
| Hospital Charge Code |
7982979
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$485.80 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Aetna of IA Commercial |
$624.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$624.60
|
| Rate for Payer: Cash Price |
$555.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$520.50
|
| Rate for Payer: Medical Associates Commercial |
$520.50
|
| Rate for Payer: Midlands Choice Commercial |
$485.80
|
| Rate for Payer: United Healthcare Commercial |
$624.60
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
4862798
|
|
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
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
OP
|
$629.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
4862797
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$283.05 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: Aetna of IA Commercial |
$566.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$566.10
|
| Rate for Payer: Aetna of IA Medicare |
$358.53
|
| Rate for Payer: Amerigroup Medicaid |
$362.81
|
| Rate for Payer: Amerigroup Medicare |
$285.88
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$471.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$283.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$359.28
|
| Rate for Payer: Medical Associates Commercial |
$471.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$283.05
|
| Rate for Payer: Midlands Choice Commercial |
$440.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$364.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$325.51
|
| Rate for Payer: United Healthcare Commercial |
$566.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$371.11
|
| Rate for Payer: Wellmark IA HMO WHPI |
$302.74
|
| Rate for Payer: Wellmark IA PPO |
$333.49
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
4862797
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$440.30 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: Aetna of IA Commercial |
$566.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$566.10
|
| Rate for Payer: Cash Price |
$503.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$471.75
|
| Rate for Payer: Medical Associates Commercial |
$471.75
|
| Rate for Payer: Midlands Choice Commercial |
$440.30
|
| Rate for Payer: United Healthcare Commercial |
$566.10
|
|
|
REMOVE FOREIGN BODY
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 10121
|
| Hospital Charge Code |
4862798
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$2,975.61 |
| 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 |
$2,701.29
|
| Rate for Payer: Wellmark IA PPO |
$2,975.61
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$180.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
4866827
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$103.82
|
| Rate for Payer: Amerigroup Medicare |
$81.81
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.82
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.15
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
| Rate for Payer: Wellmark IA HMO WHPI |
$146.76
|
| Rate for Payer: Wellmark IA PPO |
$161.67
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
4866831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$161.67 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Aetna of IA Medicare |
$82.08
|
| Rate for Payer: Amerigroup Medicaid |
$83.06
|
| Rate for Payer: Amerigroup Medicare |
$65.45
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$82.25
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.80
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$83.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.52
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.96
|
| Rate for Payer: Wellmark IA HMO WHPI |
$146.76
|
| Rate for Payer: Wellmark IA PPO |
$161.67
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
7982762
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$90.34 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Amerigroup Medicaid |
$158.40
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$156.87
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$157.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| Rate for Payer: United Healthcare Commercial |
$90.34
|
| Rate for Payer: Wellmark IA HMO WHPI |
$114.50
|
| Rate for Payer: Wellmark IA PPO |
$134.70
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 65220
|
| Hospital Charge Code |
4866831
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Aetna of IA Commercial |
$129.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$129.60
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.00
|
| Rate for Payer: Medical Associates Commercial |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$100.80
|
| Rate for Payer: United Healthcare Commercial |
$129.60
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Facility
|
IP
|
$180.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
4866827
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
REMOVE FOREIGN BODY FROM EYE
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
CPT 65205
|
| Hospital Charge Code |
7982763
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$53.50 |
| Max. Negotiated Rate |
$125.41 |
| Rate for Payer: Amerigroup Medicaid |
$125.41
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$124.20
|
| Rate for Payer: Medical Associates Commercial |
$111.00
|
| Rate for Payer: Midlands Choice Commercial |
$103.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$124.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.00
|
| Rate for Payer: United Healthcare Commercial |
$57.58
|
| Rate for Payer: Wellmark IA HMO WHPI |
$53.50
|
| Rate for Payer: Wellmark IA PPO |
$62.90
|
|
