|
28285 Correction hammertoe
|
Professional
|
Both
|
$1,808.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
8799140
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$355.78 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Amerigroup Medicaid |
$359.26
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Cash Price |
$1,446.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$355.78
|
| Rate for Payer: Medical Associates Commercial |
$1,356.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,265.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$357.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,356.00
|
| Rate for Payer: United Healthcare Commercial |
$825.30
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,020.90
|
| Rate for Payer: Wellmark IA PPO |
$1,201.00
|
|
|
28288 Ostectomy partial metatarsal head
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
8799141
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$354.69 |
| Max. Negotiated Rate |
$1,539.75 |
| Rate for Payer: Amerigroup Medicaid |
$358.17
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$354.69
|
| Rate for Payer: Medical Associates Commercial |
$1,539.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,437.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$356.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,539.75
|
| Rate for Payer: United Healthcare Commercial |
$934.67
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,141.60
|
| Rate for Payer: Wellmark IA PPO |
$1,343.10
|
|
|
28291 Hallux rigidus correction w/cheilectomy of 1st MTP w/ implant
|
Professional
|
Both
|
$2,451.00
|
|
|
Service Code
|
CPT 28291
|
| Hospital Charge Code |
8799142
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$685.32 |
| Max. Negotiated Rate |
$1,838.25 |
| Rate for Payer: Amerigroup Medicaid |
$692.04
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Cash Price |
$1,960.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$685.32
|
| Rate for Payer: Medical Associates Commercial |
$1,838.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,715.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$688.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,838.25
|
| Rate for Payer: United Healthcare Commercial |
$1,124.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,300.10
|
| Rate for Payer: Wellmark IA PPO |
$1,529.60
|
|
|
28295 Correction hallux valgus/w sesmoidectomy w/ proximal metarsal osteotomy
|
Professional
|
Both
|
$3,328.00
|
|
|
Service Code
|
CPT 28295
|
| Hospital Charge Code |
8799143
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$876.69 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Amerigroup Medicaid |
$885.28
|
| Rate for Payer: Cash Price |
$2,662.40
|
| Rate for Payer: Cash Price |
$2,662.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$876.69
|
| Rate for Payer: Medical Associates Commercial |
$2,496.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,329.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$880.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,496.00
|
| Rate for Payer: United Healthcare Commercial |
$1,513.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,977.60
|
| Rate for Payer: Wellmark IA PPO |
$2,326.60
|
|
|
28296 Correction hallux valgus (bunionectomy) w/sesamoidectomy
|
Professional
|
Both
|
$3,070.00
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
8799144
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$641.72 |
| Max. Negotiated Rate |
$2,302.50 |
| Rate for Payer: Amerigroup Medicaid |
$648.01
|
| Rate for Payer: Cash Price |
$2,456.00
|
| Rate for Payer: Cash Price |
$2,456.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$641.72
|
| Rate for Payer: Medical Associates Commercial |
$2,302.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,149.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$644.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,302.50
|
| Rate for Payer: United Healthcare Commercial |
$1,394.24
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,668.10
|
| Rate for Payer: Wellmark IA PPO |
$1,962.50
|
|
|
28308 Osteotomy w/or w/o lengthening shortening; metatarsal
|
Professional
|
Both
|
$1,916.00
|
|
|
Service Code
|
CPT 28308
|
| Hospital Charge Code |
8799145
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$396.91 |
| Max. Negotiated Rate |
$1,437.00 |
| Rate for Payer: Amerigroup Medicaid |
$400.80
|
| Rate for Payer: Cash Price |
$1,532.80
|
| Rate for Payer: Cash Price |
$1,532.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$396.91
|
| Rate for Payer: Medical Associates Commercial |
$1,437.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,341.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$398.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,437.00
|
| Rate for Payer: United Healthcare Commercial |
$872.62
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,081.30
|
| Rate for Payer: Wellmark IA PPO |
$1,272.10
|
|
|
28313 Recontruction angular deformity to toe soft tissue procedures only
|
Professional
|
Both
|
$1,754.00
|
|
|
Service Code
|
CPT 28313
|
| Hospital Charge Code |
8799146
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$352.55 |
| Max. Negotiated Rate |
$1,315.50 |
| Rate for Payer: Amerigroup Medicaid |
$356.01
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Cash Price |
$1,403.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$352.55
|
| Rate for Payer: Medical Associates Commercial |
$1,315.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,227.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$354.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,315.50
|
| Rate for Payer: United Healthcare Commercial |
$802.77
|
| Rate for Payer: Wellmark IA HMO WHPI |
$999.50
|
| Rate for Payer: Wellmark IA PPO |
$1,175.90
|
|
|
28415 Open treatment of calcaneal fracture
|
Professional
|
Both
|
$3,751.00
|
|
|
Service Code
|
CPT 28415
|
| Hospital Charge Code |
8799147
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,356.91 |
| Max. Negotiated Rate |
$2,813.25 |
| Rate for Payer: Amerigroup Medicaid |
$1,370.21
|
| Rate for Payer: Cash Price |
$3,000.80
|
| Rate for Payer: Cash Price |
$3,000.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,356.91
|
| Rate for Payer: Medical Associates Commercial |
$2,813.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,625.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,363.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,813.25
|
| Rate for Payer: United Healthcare Commercial |
$1,704.48
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,130.40
|
| Rate for Payer: Wellmark IA PPO |
$2,506.40
|
|
|
28485 Open treatment of metatarsal fracture; includes internal fixation
|
Professional
|
Both
|
$1,827.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
8799148
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$639.07 |
| Max. Negotiated Rate |
$1,370.25 |
| Rate for Payer: Amerigroup Medicaid |
$645.34
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Cash Price |
$1,461.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$639.07
|
| Rate for Payer: Medical Associates Commercial |
$1,370.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,278.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$642.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,370.25
|
| Rate for Payer: United Healthcare Commercial |
$846.51
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,078.10
|
| Rate for Payer: Wellmark IA PPO |
$1,268.40
|
|
|
28740 Arthrodesis midtarsal or tarsometatarsal single joint
|
Professional
|
Both
|
$2,823.00
|
|
|
Service Code
|
CPT 28740
|
| Hospital Charge Code |
8799149
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$553.36 |
| Max. Negotiated Rate |
$2,117.25 |
| Rate for Payer: Amerigroup Medicaid |
$558.79
|
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Cash Price |
$2,258.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$553.36
|
| Rate for Payer: Medical Associates Commercial |
$2,117.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,976.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$556.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,117.25
|
| Rate for Payer: United Healthcare Commercial |
$1,282.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,562.40
|
| Rate for Payer: Wellmark IA PPO |
$1,838.20
|
|
|
28820 Amputate toe metatarsophalangeal joint
|
Professional
|
Both
|
$1,887.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
8799150
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$352.58 |
| Max. Negotiated Rate |
$1,415.25 |
| Rate for Payer: Amerigroup Medicaid |
$356.04
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Cash Price |
$1,509.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$352.58
|
| Rate for Payer: Medical Associates Commercial |
$1,415.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,320.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$354.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,415.25
|
| Rate for Payer: United Healthcare Commercial |
$854.35
|
| Rate for Payer: Wellmark IA HMO WHPI |
$559.20
|
| Rate for Payer: Wellmark IA PPO |
$657.90
|
|
|
28825 Amputate toe interphalangeal joint
|
Professional
|
Both
|
$1,807.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
8799151
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$307.67 |
| Max. Negotiated Rate |
$1,355.25 |
| Rate for Payer: Amerigroup Medicaid |
$310.69
|
| Rate for Payer: Cash Price |
$1,445.60
|
| Rate for Payer: Cash Price |
$1,445.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$307.67
|
| Rate for Payer: Medical Associates Commercial |
$1,355.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,264.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$309.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,355.25
|
| Rate for Payer: United Healthcare Commercial |
$817.54
|
| Rate for Payer: Wellmark IA HMO WHPI |
$550.40
|
| Rate for Payer: Wellmark IA PPO |
$647.50
|
|
|
29580 APPLICATION OF PASTE BOOT (UNNA)
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
8799153
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Amerigroup Medicaid |
$52.27
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.76
|
| Rate for Payer: Medical Associates Commercial |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$147.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$157.50
|
| Rate for Payer: United Healthcare Commercial |
$94.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$120.80
|
| Rate for Payer: Wellmark IA PPO |
$142.10
|
|
|
29581 COMPRESSION MULTILAYER BELOW KNEE
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
8799154
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$74.83 |
| Max. Negotiated Rate |
$222.00 |
| Rate for Payer: Amerigroup Medicaid |
$75.56
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.83
|
| Rate for Payer: Medical Associates Commercial |
$222.00
|
| Rate for Payer: Midlands Choice Commercial |
$207.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$222.00
|
| Rate for Payer: United Healthcare Commercial |
$135.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$166.10
|
| Rate for Payer: Wellmark IA PPO |
$195.40
|
|
|
29807 Arthroscopy shoulder surgical repair of SLAP lesion
|
Professional
|
Both
|
$3,485.00
|
|
|
Service Code
|
CPT 29807
|
| Hospital Charge Code |
8799155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$952.90 |
| Max. Negotiated Rate |
$2,613.75 |
| Rate for Payer: Amerigroup Medicaid |
$962.25
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Cash Price |
$2,788.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$952.90
|
| Rate for Payer: Medical Associates Commercial |
$2,613.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,439.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$957.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,613.75
|
| Rate for Payer: United Healthcare Commercial |
$1,563.97
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,966.90
|
| Rate for Payer: Wellmark IA PPO |
$2,314.00
|
|
|
29826 Arthroscopy shoulder surgical; decompression of subacromial space
|
Professional
|
Both
|
$591.00
|
|
|
Service Code
|
CPT 29826
|
| Hospital Charge Code |
8799156
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$264.70 |
| Max. Negotiated Rate |
$682.60 |
| Rate for Payer: Amerigroup Medicaid |
$682.60
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Cash Price |
$472.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$675.97
|
| Rate for Payer: Medical Associates Commercial |
$443.25
|
| Rate for Payer: Midlands Choice Commercial |
$413.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$679.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$443.25
|
| Rate for Payer: United Healthcare Commercial |
$264.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$320.80
|
| Rate for Payer: Wellmark IA PPO |
$377.40
|
|
|
29827 Arthroscopy shoulder surgical; with rotator cuff repair
|
Professional
|
Both
|
$3,542.00
|
|
|
Service Code
|
CPT 29827
|
| Hospital Charge Code |
8799157
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$977.30 |
| Max. Negotiated Rate |
$2,656.50 |
| Rate for Payer: Amerigroup Medicaid |
$986.88
|
| Rate for Payer: Cash Price |
$2,833.60
|
| Rate for Payer: Cash Price |
$2,833.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$977.30
|
| Rate for Payer: Medical Associates Commercial |
$2,656.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,479.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$982.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,656.50
|
| Rate for Payer: United Healthcare Commercial |
$1,619.47
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,029.20
|
| Rate for Payer: Wellmark IA PPO |
$2,387.20
|
|
|
29867 Arthroscopy knee surgical; osteochondral allograft
|
Professional
|
Both
|
$4,311.00
|
|
|
Service Code
|
CPT 29867
|
| Hospital Charge Code |
8799158
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,162.40 |
| Max. Negotiated Rate |
$3,233.25 |
| Rate for Payer: Amerigroup Medicaid |
$1,173.80
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,162.40
|
| Rate for Payer: Medical Associates Commercial |
$3,233.25
|
| Rate for Payer: Midlands Choice Commercial |
$3,017.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,168.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,233.25
|
| Rate for Payer: United Healthcare Commercial |
$1,930.86
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,429.20
|
| Rate for Payer: Wellmark IA PPO |
$2,857.90
|
|
|
29874 Arthroscopy; knee with removal of loose/foreign body
|
Professional
|
Both
|
$1,801.00
|
|
|
Service Code
|
CPT 29874
|
| Hospital Charge Code |
8799159
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$493.99 |
| Max. Negotiated Rate |
$1,350.75 |
| Rate for Payer: Amerigroup Medicaid |
$498.83
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Cash Price |
$1,440.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$493.99
|
| Rate for Payer: Medical Associates Commercial |
$1,350.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,260.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$496.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,350.75
|
| Rate for Payer: United Healthcare Commercial |
$812.16
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,031.60
|
| Rate for Payer: Wellmark IA PPO |
$1,213.60
|
|
|
29877 Arthroscopy knee w/debridement/shaving of cartilage (chondroplasty)
|
Professional
|
Both
|
$2,087.00
|
|
|
Service Code
|
CPT 29877
|
| Hospital Charge Code |
8799160
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$571.81 |
| Max. Negotiated Rate |
$1,565.25 |
| Rate for Payer: Amerigroup Medicaid |
$577.42
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Cash Price |
$1,669.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$571.81
|
| Rate for Payer: Medical Associates Commercial |
$1,565.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,460.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$574.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,565.25
|
| Rate for Payer: United Healthcare Commercial |
$937.68
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,188.20
|
| Rate for Payer: Wellmark IA PPO |
$1,397.90
|
|
|
29879 Arthroscopy knee surgical; abrasion arthroplasty-drilling/microfracture
|
Professional
|
Both
|
$2,223.00
|
|
|
Service Code
|
CPT 29879
|
| Hospital Charge Code |
8799161
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$609.67 |
| Max. Negotiated Rate |
$1,667.25 |
| Rate for Payer: Amerigroup Medicaid |
$615.65
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$609.67
|
| Rate for Payer: Medical Associates Commercial |
$1,667.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$612.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,667.25
|
| Rate for Payer: United Healthcare Commercial |
$999.55
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,265.50
|
| Rate for Payer: Wellmark IA PPO |
$1,488.90
|
|
|
29880 Arthroscopy; knee with meniscenctomy medial/lateral w/shaving
|
Professional
|
Both
|
$1,885.00
|
|
|
Service Code
|
CPT 29880
|
| Hospital Charge Code |
8799162
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$516.98 |
| Max. Negotiated Rate |
$1,413.75 |
| Rate for Payer: Amerigroup Medicaid |
$522.05
|
| Rate for Payer: Cash Price |
$1,508.00
|
| Rate for Payer: Cash Price |
$1,508.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$516.98
|
| Rate for Payer: Medical Associates Commercial |
$1,413.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,319.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$519.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,413.75
|
| Rate for Payer: United Healthcare Commercial |
$848.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,076.80
|
| Rate for Payer: Wellmark IA PPO |
$1,266.90
|
|
|
29881 Arthroscopy knee surgical; with meniscectomy (medial OR lateral)
|
Professional
|
Both
|
$1,816.00
|
|
|
Service Code
|
CPT 29881
|
| Hospital Charge Code |
8799163
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$497.40 |
| Max. Negotiated Rate |
$1,362.00 |
| Rate for Payer: Amerigroup Medicaid |
$502.28
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Cash Price |
$1,452.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$497.40
|
| Rate for Payer: Medical Associates Commercial |
$1,362.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,271.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$499.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,362.00
|
| Rate for Payer: United Healthcare Commercial |
$816.85
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,037.80
|
| Rate for Payer: Wellmark IA PPO |
$1,221.00
|
|
|
29893 Endoscopic plantar fasciotomy
|
Professional
|
Both
|
$2,136.00
|
|
|
Service Code
|
CPT 29893
|
| Hospital Charge Code |
8799164
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$363.69 |
| Max. Negotiated Rate |
$1,602.00 |
| Rate for Payer: Amerigroup Medicaid |
$367.26
|
| Rate for Payer: Cash Price |
$1,708.80
|
| Rate for Payer: Cash Price |
$1,708.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$363.69
|
| Rate for Payer: Medical Associates Commercial |
$1,602.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,495.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$365.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,602.00
|
| Rate for Payer: United Healthcare Commercial |
$978.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,259.30
|
| Rate for Payer: Wellmark IA PPO |
$1,481.50
|
|
|
2cmx3cm THIN GRAFT
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8781513
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,863.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,863.00
|
| Rate for Payer: Cash Price |
$1,656.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,552.50
|
| Rate for Payer: Medical Associates Commercial |
$1,552.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,449.00
|
| Rate for Payer: United Healthcare Commercial |
$1,863.00
|
|
