|
2.7MM TI VA LOCKING SCREW 44MM
|
Facility
IP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.70 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
|
|
2.7MM TI VA LOCKING SCREW 44MM
|
Facility
OP
|
$211.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8748727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$105.46 |
| Max. Negotiated Rate |
$189.90 |
| Rate for Payer: Aetna of IA Commercial |
$189.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$189.90
|
| Rate for Payer: Aetna of IA Medicare |
$120.27
|
| Rate for Payer: Amerigroup Medicaid |
$106.49
|
| Rate for Payer: Amerigroup Medicare |
$106.56
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$158.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$105.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$105.46
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$105.50
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$107.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.25
|
| Rate for Payer: United Healthcare Commercial |
$189.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$124.49
|
|
|
2.7MM X 12MM LOCKING SCREW
|
Facility
OP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8834633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$166.43 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Aetna of IA Medicare |
$189.81
|
| Rate for Payer: Amerigroup Medicaid |
$168.07
|
| Rate for Payer: Amerigroup Medicare |
$168.16
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.43
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.50
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$169.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.75
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.47
|
|
|
2.7MM X 12MM LOCKING SCREW
|
Facility
IP
|
$333.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8834633
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.10 |
| Max. Negotiated Rate |
$299.70 |
| Rate for Payer: Aetna of IA Commercial |
$299.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.70
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.75
|
| Rate for Payer: Medical Associates Commercial |
$249.75
|
| Rate for Payer: Midlands Choice Commercial |
$233.10
|
| Rate for Payer: United Healthcare Commercial |
$299.70
|
|
|
2.7MM X 20MM NON LOCKING SCREW
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8834631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$98.96 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
2.7MM X 20MM NON LOCKING SCREW
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8834631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
2.7MM X 24MM NON LOCKING SCREW
|
Facility
OP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.96 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Aetna of IA Medicare |
$123.12
|
| Rate for Payer: Amerigroup Medicaid |
$109.02
|
| Rate for Payer: Amerigroup Medicare |
$109.08
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$108.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.96
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$127.44
|
|
|
2.7MM X 24MM NON LOCKING SCREW
|
Facility
IP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956478
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
|
|
2.7MM X 26MM NON LOCKING SCREW
|
Facility
OP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.96 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Aetna of IA Medicare |
$123.12
|
| Rate for Payer: Amerigroup Medicaid |
$109.02
|
| Rate for Payer: Amerigroup Medicare |
$109.08
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$108.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.96
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$127.44
|
|
|
2.7MM X 26MM NON LOCKING SCREW
|
Facility
IP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956480
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
|
|
2.7MM X 28MM NON LOCKING SCREW
|
Facility
IP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
|
|
2.7MM X 28MM NON LOCKING SCREW
|
Facility
OP
|
$216.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8956482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$107.96 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Aetna of IA Commercial |
$194.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$194.40
|
| Rate for Payer: Aetna of IA Medicare |
$123.12
|
| Rate for Payer: Amerigroup Medicaid |
$109.02
|
| Rate for Payer: Amerigroup Medicare |
$109.08
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$162.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$108.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$107.96
|
| Rate for Payer: Medical Associates Commercial |
$162.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$108.00
|
| Rate for Payer: Midlands Choice Commercial |
$151.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$109.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$194.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$127.44
|
|
|
28035 Release tarsal tunnel- tibial nerve
|
Professional
|
$1,771.00
|
|
|
Service Code
|
CPT 28035
|
| Hospital Charge Code |
8799133
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$330.31 |
| Max. Negotiated Rate |
$1,239.70 |
| Rate for Payer: Aetna of IA Medicare |
$330.31
|
| Rate for Payer: Amerigroup Medicaid |
$341.54
|
| Rate for Payer: Cash Price |
$1,416.80
|
| Rate for Payer: Cash Price |
$1,416.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$396.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$336.92
|
| Rate for Payer: Medical Associates Commercial |
$627.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$330.31
|
| Rate for Payer: Midlands Choice Commercial |
$1,239.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$495.46
|
| Rate for Payer: Wellmark IA HMO |
$684.00
|
| Rate for Payer: Wellmark IA PPO |
$802.00
|
|
|
28080 Excision interdigital morton neuroma single each
|
Professional
|
$1,772.00
|
|
|
Service Code
|
CPT 28080
|
| Hospital Charge Code |
8799134
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$349.73 |
| Max. Negotiated Rate |
$1,240.40 |
| Rate for Payer: Aetna of IA Medicare |
$349.73
|
| Rate for Payer: Amerigroup Medicaid |
$361.62
|
| Rate for Payer: Cash Price |
$1,417.60
|
| Rate for Payer: Cash Price |
$1,417.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$419.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$356.72
|
| Rate for Payer: Medical Associates Commercial |
$664.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$349.73
|
| Rate for Payer: Midlands Choice Commercial |
$1,240.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$524.60
|
| Rate for Payer: Wellmark IA HMO |
$719.00
|
| Rate for Payer: Wellmark IA PPO |
$844.00
|
|
|
28090 Excision ganglion cyst- foot
|
Professional
|
$1,585.00
|
|
|
Service Code
|
CPT 28090
|
| Hospital Charge Code |
8799135
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$285.77 |
| Max. Negotiated Rate |
$1,109.50 |
| Rate for Payer: Aetna of IA Medicare |
$285.77
|
| Rate for Payer: Amerigroup Medicaid |
$295.49
|
| Rate for Payer: Cash Price |
$1,268.00
|
| Rate for Payer: Cash Price |
$1,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$342.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$291.49
|
| Rate for Payer: Medical Associates Commercial |
$542.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$285.77
|
| Rate for Payer: Midlands Choice Commercial |
$1,109.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$428.66
|
| Rate for Payer: Wellmark IA HMO |
$586.00
|
| Rate for Payer: Wellmark IA PPO |
$688.00
|
|
|
28108 Excision/curettage of bone cyst/B9 tumor phalanges of foot
|
Professional
|
$1,486.00
|
|
|
Service Code
|
CPT 28108
|
| Hospital Charge Code |
8799136
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$267.86 |
| Max. Negotiated Rate |
$1,040.20 |
| Rate for Payer: Aetna of IA Medicare |
$267.86
|
| Rate for Payer: Amerigroup Medicaid |
$276.97
|
| Rate for Payer: Cash Price |
$1,188.80
|
| Rate for Payer: Cash Price |
$1,188.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$321.43
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$273.22
|
| Rate for Payer: Medical Associates Commercial |
$508.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$267.86
|
| Rate for Payer: Midlands Choice Commercial |
$1,040.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$401.79
|
| Rate for Payer: Wellmark IA HMO |
$547.00
|
| Rate for Payer: Wellmark IA PPO |
$642.00
|
|
|
28112 Ostectomy complete other metatarsal head (2nd 3rd or 4th)
|
Professional
|
$1,646.00
|
|
|
Service Code
|
CPT 28112
|
| Hospital Charge Code |
8799137
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$289.43 |
| Max. Negotiated Rate |
$1,152.20 |
| Rate for Payer: Aetna of IA Medicare |
$289.43
|
| Rate for Payer: Amerigroup Medicaid |
$299.27
|
| Rate for Payer: Cash Price |
$1,316.80
|
| Rate for Payer: Cash Price |
$1,316.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$347.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$295.22
|
| Rate for Payer: Medical Associates Commercial |
$549.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$289.43
|
| Rate for Payer: Midlands Choice Commercial |
$1,152.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$434.14
|
| Rate for Payer: Wellmark IA HMO |
$596.00
|
| Rate for Payer: Wellmark IA PPO |
$700.00
|
|
|
28122 Partial excision; tarsal/metatarsal bone
|
Professional
|
$2,003.00
|
|
|
Service Code
|
CPT 28122
|
| Hospital Charge Code |
8799138
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$405.97 |
| Max. Negotiated Rate |
$1,402.10 |
| Rate for Payer: Aetna of IA Medicare |
$405.97
|
| Rate for Payer: Amerigroup Medicaid |
$419.77
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Cash Price |
$1,602.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$487.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$414.09
|
| Rate for Payer: Medical Associates Commercial |
$771.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$405.97
|
| Rate for Payer: Midlands Choice Commercial |
$1,402.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$608.96
|
| Rate for Payer: Wellmark IA HMO |
$832.00
|
| Rate for Payer: Wellmark IA PPO |
$977.00
|
|
|
28234 Tenotomy open extensor foot or toe each tendon
|
Professional
|
$1,378.00
|
|
|
Service Code
|
CPT 28234
|
| Hospital Charge Code |
8799139
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$249.85 |
| Max. Negotiated Rate |
$964.60 |
| Rate for Payer: Aetna of IA Medicare |
$249.85
|
| Rate for Payer: Amerigroup Medicaid |
$258.34
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Cash Price |
$1,102.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$299.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$254.85
|
| Rate for Payer: Medical Associates Commercial |
$474.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$249.85
|
| Rate for Payer: Midlands Choice Commercial |
$964.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$374.78
|
| Rate for Payer: Wellmark IA HMO |
$510.00
|
| Rate for Payer: Wellmark IA PPO |
$599.00
|
|
|
28285 Correction hammertoe
|
Professional
|
$1,808.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
8799140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.87 |
| Max. Negotiated Rate |
$1,265.60 |
| Rate for Payer: Aetna of IA Medicare |
$357.87
|
| Rate for Payer: Amerigroup Medicaid |
$370.04
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$429.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$365.03
|
| Rate for Payer: Medical Associates Commercial |
$679.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$357.87
|
| Rate for Payer: Midlands Choice Commercial |
$1,265.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$536.80
|
| Rate for Payer: Wellmark IA HMO |
$731.00
|
| Rate for Payer: Wellmark IA PPO |
$858.00
|
|
|
28288 Ostectomy partial metatarsal head
|
Professional
|
$2,053.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
8799141
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$402.21 |
| Max. Negotiated Rate |
$1,437.10 |
| Rate for Payer: Aetna of IA Medicare |
$402.21
|
| Rate for Payer: Amerigroup Medicaid |
$415.89
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$482.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$410.25
|
| Rate for Payer: Medical Associates Commercial |
$764.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$402.21
|
| Rate for Payer: Midlands Choice Commercial |
$1,437.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$603.32
|
| Rate for Payer: Wellmark IA HMO |
$826.00
|
| Rate for Payer: Wellmark IA PPO |
$969.00
|
|
|
28291 Hallux rigidus correction w/cheilectomy of 1st MTP w/ implant
|
Professional
|
$2,451.00
|
|
|
Service Code
|
CPT 28291
|
| Hospital Charge Code |
8799142
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$445.85 |
| Max. Negotiated Rate |
$1,715.70 |
| Rate for Payer: Aetna of IA Medicare |
$445.85
|
| Rate for Payer: Amerigroup Medicaid |
$461.01
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$535.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$454.77
|
| Rate for Payer: Medical Associates Commercial |
$847.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$445.85
|
| Rate for Payer: Midlands Choice Commercial |
$1,715.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$668.78
|
| Rate for Payer: Wellmark IA HMO |
$920.00
|
| Rate for Payer: Wellmark IA PPO |
$1,080.00
|
|
|
28295 Correction hallux valgus/w sesmoidectomy w/ proximal metarsal osteotomy
|
Professional
|
$3,328.00
|
|
|
Service Code
|
CPT 28295
|
| Hospital Charge Code |
8799143
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$551.04 |
| Max. Negotiated Rate |
$2,329.60 |
| Rate for Payer: Aetna of IA Medicare |
$551.04
|
| Rate for Payer: Amerigroup Medicaid |
$569.78
|
| Rate for Payer: Cash Price |
$2,662.40
|
| Rate for Payer: Cash Price |
$2,662.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$661.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$562.06
|
| Rate for Payer: Medical Associates Commercial |
$1,046.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$551.04
|
| Rate for Payer: Midlands Choice Commercial |
$2,329.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$826.56
|
| Rate for Payer: Wellmark IA HMO |
$1,162.00
|
| Rate for Payer: Wellmark IA PPO |
$1,364.00
|
|
|
28296 Correction hallux valgus (bunionectomy) w/sesamoidectomy
|
Professional
|
$3,070.00
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
8799144
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$2,149.00 |
| Rate for Payer: Aetna of IA Medicare |
$476.28
|
| Rate for Payer: Amerigroup Medicaid |
$492.47
|
| Rate for Payer: Cash Price |
$2,456.00
|
| Rate for Payer: Cash Price |
$2,456.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$571.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$485.81
|
| Rate for Payer: Medical Associates Commercial |
$904.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$476.28
|
| Rate for Payer: Midlands Choice Commercial |
$2,149.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$714.42
|
| Rate for Payer: Wellmark IA HMO |
$972.00
|
| Rate for Payer: Wellmark IA PPO |
$1,140.00
|
|
|
28308 Osteotomy w/or w/o lengthening shortening; metatarsal
|
Professional
|
$1,916.00
|
|
|
Service Code
|
CPT 28308
|
| Hospital Charge Code |
8799145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$357.78 |
| Max. Negotiated Rate |
$1,341.20 |
| Rate for Payer: Aetna of IA Medicare |
$357.78
|
| Rate for Payer: Amerigroup Medicaid |
$369.94
|
| Rate for Payer: Cash Price |
$1,532.80
|
| Rate for Payer: Cash Price |
$1,532.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$429.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$364.94
|
| Rate for Payer: Medical Associates Commercial |
$679.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$357.78
|
| Rate for Payer: Midlands Choice Commercial |
$1,341.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$536.67
|
| Rate for Payer: Wellmark IA HMO |
$735.00
|
| Rate for Payer: Wellmark IA PPO |
$863.00
|
|
