|
BILIRUBIN DIRECT
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
6312793
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
BILIRUBIN DIRECT
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
633670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
BILIRUBIN DIRECT
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
6312793
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
BILIRUBIN DIRECT
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
633670
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
Bilirubin Total
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
6312792
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
Bilirubin Total
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
6312792
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
BILIRUBIN TOTAL
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
BILIRUBIN TOTAL
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633672
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
BILL ABO
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
8015152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
|
|
BILL ABO
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
8015152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Aetna of IA Medicare |
$29.64
|
| Rate for Payer: Amerigroup Medicaid |
$26.24
|
| Rate for Payer: Amerigroup Medicare |
$26.26
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.99
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
Bill Alcohol Saliva 82055
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
8100912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
Bill Alcohol Saliva 82055
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
8100912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
BILL ANTIBODY ELUTION
|
Facility
IP
|
$125.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
7829178
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
|
|
BILL ANTIBODY ELUTION
|
Facility
OP
|
$125.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
7829178
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$62.48 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Aetna of IA Medicare |
$71.25
|
| Rate for Payer: Amerigroup Medicaid |
$63.09
|
| Rate for Payer: Amerigroup Medicare |
$63.12
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.48
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.50
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.75
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.75
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
BILL ANTIBODY ID
|
Facility
IP
|
$141.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
7829179
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna of IA Commercial |
$126.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.90
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.75
|
| Rate for Payer: Medical Associates Commercial |
$105.75
|
| Rate for Payer: Midlands Choice Commercial |
$98.70
|
| Rate for Payer: United Healthcare Commercial |
$126.90
|
|
|
BILL ANTIBODY ID
|
Facility
OP
|
$141.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
7829179
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.47 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna of IA Commercial |
$126.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.90
|
| Rate for Payer: Aetna of IA Medicare |
$80.37
|
| Rate for Payer: Amerigroup Medicaid |
$71.16
|
| Rate for Payer: Amerigroup Medicare |
$71.20
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.47
|
| Rate for Payer: Medical Associates Commercial |
$105.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.50
|
| Rate for Payer: Midlands Choice Commercial |
$98.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.75
|
| Rate for Payer: United Healthcare Commercial |
$126.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$83.19
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
BILL ANTIBODY SCREEN
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
7862116
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$36.84
|
| Rate for Payer: Amerigroup Medicare |
$36.86
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.49
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.75
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
BILL ANTIBODY SCREEN
|
Facility
IP
|
$73.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
7862116
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
|
BILL ANTIBODY TITER
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
7829181
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$70.20 |
| Rate for Payer: Aetna of IA Commercial |
$70.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.20
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.50
|
| Rate for Payer: Medical Associates Commercial |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$54.60
|
| Rate for Payer: United Healthcare Commercial |
$70.20
|
|
|
BILL ANTIBODY TITER
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
7829181
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of IA Commercial |
$70.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$70.20
|
| Rate for Payer: Aetna of IA Medicare |
$44.46
|
| Rate for Payer: Amerigroup Medicaid |
$39.37
|
| Rate for Payer: Amerigroup Medicare |
$39.39
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$58.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$39.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.98
|
| Rate for Payer: Medical Associates Commercial |
$58.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$54.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.50
|
| Rate for Payer: United Healthcare Commercial |
$70.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$46.02
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
BILL ANTIGEN SCREEN EACH UNIT
|
Facility
IP
|
$56.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
7829177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
|
|
BILL ANTIGEN SCREEN EACH UNIT
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
7829177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$28.28
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.00
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
BILL ANTIGEN SCREEN W/ PT. PLASMA
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
7841884
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna of IA Commercial |
$45.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.90
|
| Rate for Payer: Aetna of IA Medicare |
$29.07
|
| Rate for Payer: Amerigroup Medicaid |
$25.74
|
| Rate for Payer: Amerigroup Medicare |
$25.76
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.49
|
| Rate for Payer: Medical Associates Commercial |
$38.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$35.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.25
|
| Rate for Payer: United Healthcare Commercial |
$45.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.09
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
BILL ANTIGEN SCREEN W/ PT. PLASMA
|
Facility
IP
|
$51.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
7841884
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna of IA Commercial |
$45.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.90
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.25
|
| Rate for Payer: Medical Associates Commercial |
$38.25
|
| Rate for Payer: Midlands Choice Commercial |
$35.70
|
| Rate for Payer: United Healthcare Commercial |
$45.90
|
|
|
BILL AUTOLOGOUS BLOOD EA
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
CPT 86890
|
| Hospital Charge Code |
8015151
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$101.70 |
| Rate for Payer: Aetna of IA Commercial |
$101.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$101.70
|
| Rate for Payer: Aetna of IA Medicare |
$64.41
|
| Rate for Payer: Amerigroup Medicaid |
$57.03
|
| Rate for Payer: Amerigroup Medicare |
$57.06
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.48
|
| Rate for Payer: Medical Associates Commercial |
$84.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.75
|
| Rate for Payer: United Healthcare Commercial |
$101.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$66.67
|
| Rate for Payer: Wellmark IA HMO |
$55.18
|
| Rate for Payer: Wellmark IA PPO |
$60.70
|
|
