|
2.4mmx24mm CANNULATED SCREW
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8465010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
2.4mmx24mm CANNULATED SCREW
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8465010
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
2.4MMX30MM CANNULATED SCREW
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8465012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
2.4MMX30MM CANNULATED SCREW
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8465012
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
2.4MMX32MM LDA SCREW
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8465014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
|
|
2.4MMX32MM LDA SCREW
|
Facility
OP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8465014
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Aetna of IA Medicare |
$277.02
|
| Rate for Payer: Amerigroup Medicaid |
$245.28
|
| Rate for Payer: Amerigroup Medicare |
$245.43
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$243.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$242.90
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$243.00
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$246.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$364.50
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$286.74
|
|
|
2.4MMX46MM TIGER CANNULATED SCREW
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
|
|
2.4MMX46MM TIGER CANNULATED SCREW
|
Facility
OP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Aetna of IA Medicare |
$277.02
|
| Rate for Payer: Amerigroup Medicaid |
$245.28
|
| Rate for Payer: Amerigroup Medicare |
$245.43
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$243.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$242.90
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$243.00
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$246.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$364.50
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$286.74
|
|
|
2.4MMX48MM TIGER CANNULATED SCREW
|
Facility
IP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
|
|
2.4MMX48MM TIGER CANNULATED SCREW
|
Facility
OP
|
$486.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8463484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Aetna of IA Medicare |
$277.02
|
| Rate for Payer: Amerigroup Medicaid |
$245.28
|
| Rate for Payer: Amerigroup Medicare |
$245.43
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$243.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$242.90
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$243.00
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$246.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$364.50
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$286.74
|
|
|
2.4 THREAD PILOT DRILL,TWO-STEP HAMMER TOE INST (DISP)
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8749765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$158.98
|
| Rate for Payer: Amerigroup Medicare |
$159.08
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$157.44
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$159.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
2.4 THREAD PILOT DRILL,TWO-STEP HAMMER TOE INST (DISP)
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8749765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
25112 Excision tumor soft tissue of neck/ant thorax sub q 3 cm +
|
Professional
|
$1,500.00
|
|
|
Service Code
|
CPT 25112
|
| Hospital Charge Code |
8799118
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$359.81 |
| Max. Negotiated Rate |
$1,050.00 |
| Rate for Payer: Aetna of IA Medicare |
$359.81
|
| Rate for Payer: Amerigroup Medicaid |
$372.04
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Cash Price |
$1,200.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$431.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$367.01
|
| Rate for Payer: Medical Associates Commercial |
$683.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$359.81
|
| Rate for Payer: Midlands Choice Commercial |
$1,050.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$539.72
|
| Rate for Payer: Wellmark IA HMO |
$756.00
|
| Rate for Payer: Wellmark IA PPO |
$888.00
|
|
|
26605 Closed treatment of metacarpal fx; single with manipulation
|
Professional
|
$1,078.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
8799119
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$278.15 |
| Max. Negotiated Rate |
$754.60 |
| Rate for Payer: Aetna of IA Medicare |
$278.15
|
| Rate for Payer: Amerigroup Medicaid |
$287.61
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$333.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$283.71
|
| Rate for Payer: Medical Associates Commercial |
$528.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$278.15
|
| Rate for Payer: Midlands Choice Commercial |
$754.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$417.22
|
| Rate for Payer: Wellmark IA HMO |
$584.00
|
| Rate for Payer: Wellmark IA PPO |
$686.00
|
|
|
27232 CLOSED REDUCTION FEMUR FRACTURE
|
Professional
|
$2,009.00
|
|
|
Service Code
|
CPT 27232
|
| Hospital Charge Code |
8069175
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$654.21 |
| Max. Negotiated Rate |
$1,631.00 |
| Rate for Payer: Aetna of IA Medicare |
$654.21
|
| Rate for Payer: Amerigroup Medicaid |
$676.45
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$785.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$667.29
|
| Rate for Payer: Medical Associates Commercial |
$1,243.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$654.21
|
| Rate for Payer: Midlands Choice Commercial |
$1,406.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$981.32
|
| Rate for Payer: Wellmark IA HMO |
$1,390.00
|
| Rate for Payer: Wellmark IA PPO |
$1,631.00
|
|
|
27331 Arthrotomy knee; inc exploration bx or removal of loose/foreign body
|
Professional
|
$1,593.00
|
|
|
Service Code
|
CPT 27331
|
| Hospital Charge Code |
8799120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$435.56 |
| Max. Negotiated Rate |
$1,115.10 |
| Rate for Payer: Aetna of IA Medicare |
$435.56
|
| Rate for Payer: Amerigroup Medicaid |
$450.37
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$522.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$444.27
|
| Rate for Payer: Medical Associates Commercial |
$827.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$435.56
|
| Rate for Payer: Midlands Choice Commercial |
$1,115.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$653.34
|
| Rate for Payer: Wellmark IA HMO |
$921.00
|
| Rate for Payer: Wellmark IA PPO |
$1,081.00
|
|
|
27415 Open osteochondral knee allograft
|
Professional
|
$4,627.00
|
|
|
Service Code
|
CPT 27415
|
| Hospital Charge Code |
8799121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,232.98 |
| Max. Negotiated Rate |
$3,238.90 |
| Rate for Payer: Aetna of IA Medicare |
$1,232.98
|
| Rate for Payer: Amerigroup Medicaid |
$1,274.90
|
| Rate for Payer: Cash Price |
$3,701.60
|
| Rate for Payer: Cash Price |
$3,701.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,479.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,257.64
|
| Rate for Payer: Medical Associates Commercial |
$2,342.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,232.98
|
| Rate for Payer: Midlands Choice Commercial |
$3,238.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,849.47
|
| Rate for Payer: Wellmark IA HMO |
$2,618.00
|
| Rate for Payer: Wellmark IA PPO |
$3,073.00
|
|
|
27427 Ligmamentous reconstruction knee; extra-articular
|
Professional
|
$2,390.00
|
|
|
Service Code
|
CPT 27427
|
| Hospital Charge Code |
8799122
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$643.62 |
| Max. Negotiated Rate |
$1,673.00 |
| Rate for Payer: Aetna of IA Medicare |
$643.62
|
| Rate for Payer: Amerigroup Medicaid |
$665.50
|
| Rate for Payer: Cash Price |
$1,912.00
|
| Rate for Payer: Cash Price |
$1,912.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$772.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$656.49
|
| Rate for Payer: Medical Associates Commercial |
$1,222.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$643.62
|
| Rate for Payer: Midlands Choice Commercial |
$1,673.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$965.43
|
| Rate for Payer: Wellmark IA HMO |
$1,364.00
|
| Rate for Payer: Wellmark IA PPO |
$1,601.00
|
|
|
27650 Repair primary ruptured Achilles tendon
|
Professional
|
$2,210.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
8799123
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$601.00 |
| Max. Negotiated Rate |
$1,547.00 |
| Rate for Payer: Aetna of IA Medicare |
$601.00
|
| Rate for Payer: Amerigroup Medicaid |
$621.43
|
| Rate for Payer: Cash Price |
$1,768.00
|
| Rate for Payer: Cash Price |
$1,768.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$721.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$613.02
|
| Rate for Payer: Medical Associates Commercial |
$1,141.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$601.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,547.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$901.50
|
| Rate for Payer: Wellmark IA HMO |
$1,260.00
|
| Rate for Payer: Wellmark IA PPO |
$1,478.00
|
|
|
27652 Repair primary ruptured Achilles tendon; with graft
|
Professional
|
$2,235.00
|
|
|
Service Code
|
CPT 27652
|
| Hospital Charge Code |
8799124
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$617.43 |
| Max. Negotiated Rate |
$1,564.50 |
| Rate for Payer: Aetna of IA Medicare |
$617.43
|
| Rate for Payer: Amerigroup Medicaid |
$638.42
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Cash Price |
$1,788.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$740.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$629.78
|
| Rate for Payer: Medical Associates Commercial |
$1,173.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$617.43
|
| Rate for Payer: Midlands Choice Commercial |
$1,564.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$926.14
|
| Rate for Payer: Wellmark IA HMO |
$1,264.00
|
| Rate for Payer: Wellmark IA PPO |
$1,484.00
|
|
|
27654 Repair secondary achilles tendon with/without graft
|
Professional
|
$2,396.00
|
|
|
Service Code
|
CPT 27654
|
| Hospital Charge Code |
8799125
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$654.99 |
| Max. Negotiated Rate |
$1,677.20 |
| Rate for Payer: Aetna of IA Medicare |
$654.99
|
| Rate for Payer: Amerigroup Medicaid |
$677.26
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Cash Price |
$1,916.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$785.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$668.09
|
| Rate for Payer: Medical Associates Commercial |
$1,244.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$654.99
|
| Rate for Payer: Midlands Choice Commercial |
$1,677.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$982.48
|
| Rate for Payer: Wellmark IA HMO |
$1,366.00
|
| Rate for Payer: Wellmark IA PPO |
$1,603.00
|
|
|
27687 Gastrocnemius recession
|
Professional
|
$1,524.00
|
|
|
Service Code
|
CPT 27687
|
| Hospital Charge Code |
8799126
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$416.93 |
| Max. Negotiated Rate |
$1,066.80 |
| Rate for Payer: Aetna of IA Medicare |
$416.93
|
| Rate for Payer: Amerigroup Medicaid |
$431.11
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$500.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$425.27
|
| Rate for Payer: Medical Associates Commercial |
$792.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$416.93
|
| Rate for Payer: Midlands Choice Commercial |
$1,066.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$625.40
|
| Rate for Payer: Wellmark IA HMO |
$868.00
|
| Rate for Payer: Wellmark IA PPO |
$1,019.00
|
|
|
27691 Transfer single tendon; deep foot
|
Professional
|
$2,503.00
|
|
|
Service Code
|
CPT 27691
|
| Hospital Charge Code |
8799127
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$677.00 |
| Max. Negotiated Rate |
$1,752.10 |
| Rate for Payer: Aetna of IA Medicare |
$677.00
|
| Rate for Payer: Amerigroup Medicaid |
$700.02
|
| Rate for Payer: Cash Price |
$2,002.40
|
| Rate for Payer: Cash Price |
$2,002.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$812.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$690.54
|
| Rate for Payer: Medical Associates Commercial |
$1,286.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$677.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,752.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,015.50
|
| Rate for Payer: Wellmark IA HMO |
$1,422.00
|
| Rate for Payer: Wellmark IA PPO |
$1,669.00
|
|
|
27698 Repair secondary disrupted ligament ankle collateral
|
Professional
|
$2,145.00
|
|
|
Service Code
|
CPT 27698
|
| Hospital Charge Code |
8799128
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$582.41 |
| Max. Negotiated Rate |
$1,501.50 |
| Rate for Payer: Aetna of IA Medicare |
$582.41
|
| Rate for Payer: Amerigroup Medicaid |
$602.21
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Cash Price |
$1,716.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$698.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$594.06
|
| Rate for Payer: Medical Associates Commercial |
$1,106.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$582.41
|
| Rate for Payer: Midlands Choice Commercial |
$1,501.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$873.62
|
| Rate for Payer: Wellmark IA HMO |
$1,224.00
|
| Rate for Payer: Wellmark IA PPO |
$1,437.00
|
|
|
27769 Open treatment posterior malleolus fracture
|
Professional
|
$2,452.00
|
|
|
Service Code
|
CPT 27769
|
| Hospital Charge Code |
8799129
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$658.52 |
| Max. Negotiated Rate |
$1,716.40 |
| Rate for Payer: Aetna of IA Medicare |
$658.52
|
| Rate for Payer: Amerigroup Medicaid |
$680.91
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$790.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$671.69
|
| Rate for Payer: Medical Associates Commercial |
$1,251.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$658.52
|
| Rate for Payer: Midlands Choice Commercial |
$1,716.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$987.78
|
| Rate for Payer: Wellmark IA HMO |
$1,394.00
|
| Rate for Payer: Wellmark IA PPO |
$1,636.00
|
|
