|
26123 Dupuytrens
|
Professional
|
Both
|
$2,979.00
|
|
|
Service Code
|
CPT 26123
|
| Hospital Charge Code |
8981173
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$733.95 |
| Max. Negotiated Rate |
$2,234.25 |
| Rate for Payer: Amerigroup Medicaid |
$741.15
|
| Rate for Payer: Cash Price |
$2,383.20
|
| Rate for Payer: Cash Price |
$2,383.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$733.95
|
| Rate for Payer: Medical Associates Commercial |
$2,234.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,085.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$737.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,234.25
|
| Rate for Payer: United Healthcare Commercial |
$1,263.09
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,606.50
|
| Rate for Payer: Wellmark IA PPO |
$1,890.00
|
|
|
26125 Dupuytrens additional fingers
|
Professional
|
Both
|
$933.00
|
|
|
Service Code
|
CPT 26125
|
| Hospital Charge Code |
8981174
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$264.01 |
| Max. Negotiated Rate |
$699.75 |
| Rate for Payer: Amerigroup Medicaid |
$266.59
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Cash Price |
$746.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$264.01
|
| Rate for Payer: Medical Associates Commercial |
$699.75
|
| Rate for Payer: Midlands Choice Commercial |
$653.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$265.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$699.75
|
| Rate for Payer: United Healthcare Commercial |
$414.02
|
| Rate for Payer: Wellmark IA HMO WHPI |
$503.20
|
| Rate for Payer: Wellmark IA PPO |
$592.00
|
|
|
26160 Ganglion Cyst removal of fingers/hand
|
Professional
|
Both
|
$2,170.00
|
|
|
Service Code
|
CPT 26160
|
| Hospital Charge Code |
8981171
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$261.70 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Amerigroup Medicaid |
$264.27
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Cash Price |
$1,736.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$261.70
|
| Rate for Payer: Medical Associates Commercial |
$1,627.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,519.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$262.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,627.50
|
| Rate for Payer: United Healthcare Commercial |
$857.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,169.90
|
| Rate for Payer: Wellmark IA PPO |
$1,376.40
|
|
|
26480 CMC arthroplasty tendon interposition with separate incision
|
Professional
|
Both
|
$2,784.00
|
|
|
Service Code
|
CPT 26480
|
| Hospital Charge Code |
8981180
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$616.27 |
| Max. Negotiated Rate |
$2,088.00 |
| Rate for Payer: Amerigroup Medicaid |
$622.32
|
| Rate for Payer: Cash Price |
$2,227.20
|
| Rate for Payer: Cash Price |
$2,227.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$616.27
|
| Rate for Payer: Medical Associates Commercial |
$2,088.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,948.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$619.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,088.00
|
| Rate for Payer: United Healthcare Commercial |
$1,149.97
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,501.40
|
| Rate for Payer: Wellmark IA PPO |
$1,766.40
|
|
|
26605 Closed treatment of metacarpal fx; single with manipulation
|
Professional
|
Both
|
$1,078.00
|
|
|
Service Code
|
CPT 26605
|
| Hospital Charge Code |
8799119
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$272.18 |
| Max. Negotiated Rate |
$808.50 |
| Rate for Payer: Amerigroup Medicaid |
$274.85
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Cash Price |
$862.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$272.18
|
| Rate for Payer: Medical Associates Commercial |
$808.50
|
| Rate for Payer: Midlands Choice Commercial |
$754.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$273.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$808.50
|
| Rate for Payer: United Healthcare Commercial |
$489.30
|
| Rate for Payer: Wellmark IA HMO WHPI |
$650.40
|
| Rate for Payer: Wellmark IA PPO |
$765.20
|
|
|
26608 Closed reduction perc Pinning of it
|
Professional
|
Both
|
$1,731.00
|
|
|
Service Code
|
CPT 26608
|
| Hospital Charge Code |
8981170
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$381.48 |
| Max. Negotiated Rate |
$1,298.25 |
| Rate for Payer: Amerigroup Medicaid |
$385.22
|
| Rate for Payer: Cash Price |
$1,384.80
|
| Rate for Payer: Cash Price |
$1,384.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$381.48
|
| Rate for Payer: Medical Associates Commercial |
$1,298.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,211.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$383.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,298.25
|
| Rate for Payer: United Healthcare Commercial |
$724.11
|
| Rate for Payer: Wellmark IA HMO WHPI |
$933.40
|
| Rate for Payer: Wellmark IA PPO |
$1,098.20
|
|
|
26615 ORIF metacarpal fracture
|
Professional
|
Both
|
$2,056.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
8981169
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$398.90 |
| Max. Negotiated Rate |
$1,542.00 |
| Rate for Payer: Amerigroup Medicaid |
$402.81
|
| Rate for Payer: Cash Price |
$1,644.80
|
| Rate for Payer: Cash Price |
$1,644.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$398.90
|
| Rate for Payer: Medical Associates Commercial |
$1,542.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,439.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$400.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,542.00
|
| Rate for Payer: United Healthcare Commercial |
$868.77
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,108.90
|
| Rate for Payer: Wellmark IA PPO |
$1,304.60
|
|
|
26727 Treat finger fracture each
|
Professional
|
Both
|
$1,706.00
|
|
|
Service Code
|
CPT 26727
|
| Hospital Charge Code |
8981181
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$359.62 |
| Max. Negotiated Rate |
$1,279.50 |
| Rate for Payer: Amerigroup Medicaid |
$363.15
|
| Rate for Payer: Cash Price |
$1,364.80
|
| Rate for Payer: Cash Price |
$1,364.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$359.62
|
| Rate for Payer: Medical Associates Commercial |
$1,279.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,194.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$361.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,279.50
|
| Rate for Payer: United Healthcare Commercial |
$712.24
|
| Rate for Payer: Wellmark IA HMO WHPI |
$920.20
|
| Rate for Payer: Wellmark IA PPO |
$1,082.60
|
|
|
26735 Treat finger fracture each
|
Professional
|
Both
|
$2,125.00
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
8981182
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$409.08 |
| Max. Negotiated Rate |
$1,593.75 |
| Rate for Payer: Amerigroup Medicaid |
$413.09
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Cash Price |
$1,700.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$409.08
|
| Rate for Payer: Medical Associates Commercial |
$1,593.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,487.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$411.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,593.75
|
| Rate for Payer: United Healthcare Commercial |
$898.58
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,146.00
|
| Rate for Payer: Wellmark IA PPO |
$1,348.30
|
|
|
26746 Treat finger fracture each
|
Professional
|
Both
|
$2,635.00
|
|
|
Service Code
|
CPT 26746
|
| Hospital Charge Code |
8981183
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$420.43 |
| Max. Negotiated Rate |
$1,976.25 |
| Rate for Payer: Amerigroup Medicaid |
$424.56
|
| Rate for Payer: Cash Price |
$2,108.00
|
| Rate for Payer: Cash Price |
$2,108.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$420.43
|
| Rate for Payer: Medical Associates Commercial |
$1,976.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,844.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$422.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,976.25
|
| Rate for Payer: United Healthcare Commercial |
$1,123.28
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,420.90
|
| Rate for Payer: Wellmark IA PPO |
$1,671.70
|
|
|
26756 Pin finger fracture each
|
Professional
|
Both
|
$1,528.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
8981184
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$311.29 |
| Max. Negotiated Rate |
$1,146.00 |
| Rate for Payer: Amerigroup Medicaid |
$314.35
|
| Rate for Payer: Cash Price |
$1,222.40
|
| Rate for Payer: Cash Price |
$1,222.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$311.29
|
| Rate for Payer: Medical Associates Commercial |
$1,146.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,069.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$312.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,146.00
|
| Rate for Payer: United Healthcare Commercial |
$636.50
|
| Rate for Payer: Wellmark IA HMO WHPI |
$824.00
|
| Rate for Payer: Wellmark IA PPO |
$969.40
|
|
|
26765 Treat finger fracture each
|
Professional
|
Both
|
$1,806.00
|
|
|
Service Code
|
CPT 26765
|
| Hospital Charge Code |
8981185
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$305.33 |
| Max. Negotiated Rate |
$1,354.50 |
| Rate for Payer: Amerigroup Medicaid |
$308.32
|
| Rate for Payer: Cash Price |
$1,444.80
|
| Rate for Payer: Cash Price |
$1,444.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$305.33
|
| Rate for Payer: Medical Associates Commercial |
$1,354.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,264.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$306.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,354.50
|
| Rate for Payer: United Healthcare Commercial |
$757.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$973.70
|
| Rate for Payer: Wellmark IA PPO |
$1,145.50
|
|
|
27130-Total Hip Arthoplasty
|
Professional
|
Both
|
$2,900.00
|
|
|
Service Code
|
CPT 27130
|
| Hospital Charge Code |
8998301
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,422.35 |
| Max. Negotiated Rate |
$2,858.60 |
| Rate for Payer: Amerigroup Medicaid |
$1,436.29
|
| Rate for Payer: Cash Price |
$2,320.00
|
| Rate for Payer: Cash Price |
$2,320.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,422.35
|
| Rate for Payer: Medical Associates Commercial |
$2,175.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,030.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,429.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare Commercial |
$2,050.19
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,429.80
|
| Rate for Payer: Wellmark IA PPO |
$2,858.60
|
|
|
27134-Revision Hip Joint Replacement Both Components
|
Professional
|
Both
|
$4,300.00
|
|
|
Service Code
|
CPT 27134
|
| Hospital Charge Code |
8998302
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,978.26 |
| Max. Negotiated Rate |
$4,221.00 |
| Rate for Payer: Amerigroup Medicaid |
$1,997.65
|
| Rate for Payer: Cash Price |
$3,440.00
|
| Rate for Payer: Cash Price |
$3,440.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,978.26
|
| Rate for Payer: Medical Associates Commercial |
$3,225.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,010.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,987.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,225.00
|
| Rate for Payer: United Healthcare Commercial |
$2,897.34
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,587.80
|
| Rate for Payer: Wellmark IA PPO |
$4,221.00
|
|
|
27137-Revision Hip Joint Replacement Acetabular only
|
Professional
|
Both
|
$3,300.00
|
|
|
Service Code
|
CPT 27137
|
| Hospital Charge Code |
8998305
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,493.60 |
| Max. Negotiated Rate |
$3,255.30 |
| Rate for Payer: Amerigroup Medicaid |
$1,508.24
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Cash Price |
$2,640.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,493.60
|
| Rate for Payer: Medical Associates Commercial |
$2,475.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,310.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,500.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,475.00
|
| Rate for Payer: United Healthcare Commercial |
$2,226.21
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,767.00
|
| Rate for Payer: Wellmark IA PPO |
$3,255.30
|
|
|
27138-Revision Hip Joint Replacement Femoral only
|
Professional
|
Both
|
$3,400.00
|
|
|
Service Code
|
CPT 27138
|
| Hospital Charge Code |
8998464
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,554.93 |
| Max. Negotiated Rate |
$3,380.30 |
| Rate for Payer: Amerigroup Medicaid |
$1,570.17
|
| Rate for Payer: Cash Price |
$2,720.00
|
| Rate for Payer: Cash Price |
$2,720.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,554.93
|
| Rate for Payer: Medical Associates Commercial |
$2,550.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,380.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,562.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,550.00
|
| Rate for Payer: United Healthcare Commercial |
$2,314.54
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,873.30
|
| Rate for Payer: Wellmark IA PPO |
$3,380.30
|
|
|
27232 CLOSED REDUCTION FEMUR FRACTURE
|
Professional
|
Both
|
$2,009.00
|
|
|
Service Code
|
CPT 27232
|
| Hospital Charge Code |
8069175
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$704.14 |
| Max. Negotiated Rate |
$1,625.00 |
| Rate for Payer: Amerigroup Medicaid |
$711.04
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Cash Price |
$1,607.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$704.14
|
| Rate for Payer: Medical Associates Commercial |
$1,506.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,406.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$707.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,506.75
|
| Rate for Payer: United Healthcare Commercial |
$1,130.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,381.30
|
| Rate for Payer: Wellmark IA PPO |
$1,625.00
|
|
|
27331 Arthrotomy knee; inc exploration bx or removal of loose/foreign body
|
Professional
|
Both
|
$1,593.00
|
|
|
Service Code
|
CPT 27331
|
| Hospital Charge Code |
8799120
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$447.97 |
| Max. Negotiated Rate |
$1,194.75 |
| Rate for Payer: Amerigroup Medicaid |
$452.37
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Cash Price |
$1,274.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$447.97
|
| Rate for Payer: Medical Associates Commercial |
$1,194.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,115.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$450.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,194.75
|
| Rate for Payer: United Healthcare Commercial |
$716.16
|
| Rate for Payer: Wellmark IA HMO WHPI |
$919.00
|
| Rate for Payer: Wellmark IA PPO |
$1,081.10
|
|
|
27415 Open osteochondral knee allograft
|
Professional
|
Both
|
$4,627.00
|
|
|
Service Code
|
CPT 27415
|
| Hospital Charge Code |
8799121
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,232.97 |
| Max. Negotiated Rate |
$3,470.25 |
| Rate for Payer: Amerigroup Medicaid |
$1,245.05
|
| Rate for Payer: Cash Price |
$3,701.60
|
| Rate for Payer: Cash Price |
$3,701.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,232.97
|
| Rate for Payer: Medical Associates Commercial |
$3,470.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,238.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,239.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,470.25
|
| Rate for Payer: United Healthcare Commercial |
$2,074.32
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,604.10
|
| Rate for Payer: Wellmark IA PPO |
$3,063.60
|
|
|
27427 Ligmamentous reconstruction knee; extra-articular
|
Professional
|
Both
|
$2,390.00
|
|
|
Service Code
|
CPT 27427
|
| Hospital Charge Code |
8799122
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$683.81 |
| Max. Negotiated Rate |
$1,792.50 |
| Rate for Payer: Amerigroup Medicaid |
$690.51
|
| Rate for Payer: Cash Price |
$1,912.00
|
| Rate for Payer: Cash Price |
$1,912.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$683.81
|
| Rate for Payer: Medical Associates Commercial |
$1,792.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,673.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$687.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,792.50
|
| Rate for Payer: United Healthcare Commercial |
$1,075.92
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,355.50
|
| Rate for Payer: Wellmark IA PPO |
$1,594.70
|
|
|
27445-Revision of Knee Joint Hinge
|
Professional
|
Both
|
$2,900.00
|
|
|
Service Code
|
CPT 27445
|
| Hospital Charge Code |
8998308
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,242.29 |
| Max. Negotiated Rate |
$2,796.50 |
| Rate for Payer: Amerigroup Medicaid |
$1,254.47
|
| Rate for Payer: Cash Price |
$2,320.00
|
| Rate for Payer: Cash Price |
$2,320.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,242.29
|
| Rate for Payer: Medical Associates Commercial |
$2,175.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,030.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,248.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare Commercial |
$1,897.63
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,377.00
|
| Rate for Payer: Wellmark IA PPO |
$2,796.50
|
|
|
27446-Revision of Knee Joint Condyle and Plateau
|
Professional
|
Both
|
$2,600.00
|
|
|
Service Code
|
CPT 27446
|
| Hospital Charge Code |
8996256
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,133.63 |
| Max. Negotiated Rate |
$2,559.70 |
| Rate for Payer: Amerigroup Medicaid |
$1,144.74
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Cash Price |
$2,080.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,133.63
|
| Rate for Payer: Medical Associates Commercial |
$1,950.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,820.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,139.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare Commercial |
$1,751.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,175.70
|
| Rate for Payer: Wellmark IA PPO |
$2,559.70
|
|
|
27447-Total Knee Arthroplasty
|
Professional
|
Both
|
$2,900.00
|
|
|
Service Code
|
CPT 27447
|
| Hospital Charge Code |
8996257
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,505.14 |
| Max. Negotiated Rate |
$2,854.20 |
| Rate for Payer: Amerigroup Medicaid |
$1,519.90
|
| Rate for Payer: Cash Price |
$2,320.00
|
| Rate for Payer: Cash Price |
$2,320.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,505.14
|
| Rate for Payer: Medical Associates Commercial |
$2,175.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,030.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,512.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,175.00
|
| Rate for Payer: United Healthcare Commercial |
$2,048.13
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,426.10
|
| Rate for Payer: Wellmark IA PPO |
$2,854.20
|
|
|
27487-Revision Total Knee Joint
|
Professional
|
Both
|
$3,900.00
|
|
|
Service Code
|
CPT 27487
|
| Hospital Charge Code |
8998211
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,757.61 |
| Max. Negotiated Rate |
$3,893.10 |
| Rate for Payer: Amerigroup Medicaid |
$1,774.84
|
| Rate for Payer: Cash Price |
$3,120.00
|
| Rate for Payer: Cash Price |
$3,120.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,757.61
|
| Rate for Payer: Medical Associates Commercial |
$2,925.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,730.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,766.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,925.00
|
| Rate for Payer: United Healthcare Commercial |
$2,661.12
|
| Rate for Payer: Wellmark IA HMO WHPI |
$3,309.20
|
| Rate for Payer: Wellmark IA PPO |
$3,893.10
|
|
|
27650 Repair primary ruptured Achilles tendon
|
Professional
|
Both
|
$2,210.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
8799123
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$668.24 |
| Max. Negotiated Rate |
$1,657.50 |
| Rate for Payer: Amerigroup Medicaid |
$674.79
|
| Rate for Payer: Cash Price |
$1,768.00
|
| Rate for Payer: Cash Price |
$1,768.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$668.24
|
| Rate for Payer: Medical Associates Commercial |
$1,657.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,547.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$671.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,657.50
|
| Rate for Payer: United Healthcare Commercial |
$1,002.61
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,254.20
|
| Rate for Payer: Wellmark IA PPO |
$1,475.60
|
|
