|
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
|
|
|
Bill Body Fluid Cell Count 89051
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
8098792
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$67.52 |
| Rate for Payer: Aetna of IA Commercial |
$66.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.60
|
| Rate for Payer: Aetna of IA Medicare |
$42.18
|
| Rate for Payer: Amerigroup Medicaid |
$37.35
|
| Rate for Payer: Amerigroup Medicare |
$37.37
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.99
|
| Rate for Payer: Medical Associates Commercial |
$55.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.00
|
| Rate for Payer: Midlands Choice Commercial |
$51.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.50
|
| Rate for Payer: United Healthcare Commercial |
$66.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.66
|
| Rate for Payer: Wellmark IA HMO |
$61.38
|
| Rate for Payer: Wellmark IA PPO |
$67.52
|
|
|
Bill Body Fluid Cell Count 89051
|
Facility
IP
|
$74.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
8098792
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna of IA Commercial |
$66.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.60
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.50
|
| Rate for Payer: Medical Associates Commercial |
$55.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.80
|
| Rate for Payer: United Healthcare Commercial |
$66.60
|
|
|
Bill Body Fluid Crystals 89060
|
Facility
IP
|
$74.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
8098794
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna of IA Commercial |
$66.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.60
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.50
|
| Rate for Payer: Medical Associates Commercial |
$55.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.80
|
| Rate for Payer: United Healthcare Commercial |
$66.60
|
|
|
Bill Body Fluid Crystals 89060
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
8098794
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$67.52 |
| Rate for Payer: Aetna of IA Commercial |
$66.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.60
|
| Rate for Payer: Aetna of IA Medicare |
$42.18
|
| Rate for Payer: Amerigroup Medicaid |
$37.35
|
| Rate for Payer: Amerigroup Medicare |
$37.37
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.99
|
| Rate for Payer: Medical Associates Commercial |
$55.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.00
|
| Rate for Payer: Midlands Choice Commercial |
$51.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.50
|
| Rate for Payer: United Healthcare Commercial |
$66.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.66
|
| Rate for Payer: Wellmark IA HMO |
$61.38
|
| Rate for Payer: Wellmark IA PPO |
$67.52
|
|
|
Bill Chromosome Analysis 88262
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
8099069
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Aetna of IA Commercial |
$250.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$250.20
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$208.50
|
| Rate for Payer: Medical Associates Commercial |
$208.50
|
| Rate for Payer: Midlands Choice Commercial |
$194.60
|
| Rate for Payer: United Healthcare Commercial |
$250.20
|
|
|
Bill Chromosome Analysis 88262
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
8099069
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$138.94 |
| Max. Negotiated Rate |
$250.20 |
| Rate for Payer: Aetna of IA Commercial |
$250.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$250.20
|
| Rate for Payer: Aetna of IA Medicare |
$158.46
|
| Rate for Payer: Amerigroup Medicaid |
$140.31
|
| Rate for Payer: Amerigroup Medicare |
$140.39
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$208.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$139.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$138.94
|
| Rate for Payer: Medical Associates Commercial |
$208.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$139.00
|
| Rate for Payer: Midlands Choice Commercial |
$194.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$141.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$208.50
|
| Rate for Payer: United Healthcare Commercial |
$250.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$164.02
|
| Rate for Payer: Wellmark IA HMO |
$149.42
|
| Rate for Payer: Wellmark IA PPO |
$164.36
|
|
|
BILL CROSSMATCH EA
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
8015153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
BILL CROSSMATCH EA
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
8015153
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.48 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$49.97
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.48
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.25
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
Bill Cytology Fluid 88104
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
7452782
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
| Rate for Payer: Wellmark IA HMO |
$61.38
|
| Rate for Payer: Wellmark IA PPO |
$67.52
|
|
|
Bill Cytology Fluid 88104
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
7452782
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
Bill Cyto Needle Aspirate Report 88173
|
Facility
OP
|
$167.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
8099056
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$83.47 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna of IA Commercial |
$150.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$150.30
|
| Rate for Payer: Aetna of IA Medicare |
$95.19
|
| Rate for Payer: Amerigroup Medicaid |
$84.28
|
| Rate for Payer: Amerigroup Medicare |
$84.34
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$125.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$83.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$83.47
|
| Rate for Payer: Medical Associates Commercial |
$125.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$83.50
|
| Rate for Payer: Midlands Choice Commercial |
$116.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$84.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$125.25
|
| Rate for Payer: United Healthcare Commercial |
$150.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$98.53
|
| Rate for Payer: Wellmark IA HMO |
$112.84
|
| Rate for Payer: Wellmark IA PPO |
$124.12
|
|
|
Bill Cyto Needle Aspirate Report 88173
|
Facility
IP
|
$167.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
8099056
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$116.90 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna of IA Commercial |
$150.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$150.30
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$125.25
|
| Rate for Payer: Medical Associates Commercial |
$125.25
|
| Rate for Payer: Midlands Choice Commercial |
$116.90
|
| Rate for Payer: United Healthcare Commercial |
$150.30
|
|
|
Bill Cyto Smears Screening w/Interp 88160
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 88160
|
| Hospital Charge Code |
8099074
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$42.48 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Aetna of IA Medicare |
$48.45
|
| Rate for Payer: Amerigroup Medicaid |
$42.90
|
| Rate for Payer: Amerigroup Medicare |
$42.92
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.48
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.50
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.75
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.15
|
| Rate for Payer: Wellmark IA HMO |
$61.38
|
| Rate for Payer: Wellmark IA PPO |
$67.52
|
|
|
Bill Cyto Smears Screening w/Interp 88160
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 88160
|
| Hospital Charge Code |
8099074
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
|
|
Bill Cyto Thin Prep 88112
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
8099073
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
|
|
Bill Cyto Thin Prep 88112
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
8099073
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$52.48 |
| Max. Negotiated Rate |
$124.12 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Aetna of IA Medicare |
$59.85
|
| Rate for Payer: Amerigroup Medicaid |
$52.99
|
| Rate for Payer: Amerigroup Medicare |
$53.02
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.48
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.50
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.75
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.95
|
| Rate for Payer: Wellmark IA HMO |
$112.84
|
| Rate for Payer: Wellmark IA PPO |
$124.12
|
|
|
BILL DIRECT ANTIGLOBULIN
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
7864921
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
BILL DIRECT ANTIGLOBULIN
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
7864921
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$29.27
|
| Rate for Payer: Amerigroup Medicare |
$29.29
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.99
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
Bill Dna Probe 88271
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
8099070
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$109.96 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$111.03
|
| Rate for Payer: Amerigroup Medicare |
$111.10
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$110.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$109.96
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$110.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$111.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO |
$143.22
|
| Rate for Payer: Wellmark IA PPO |
$157.54
|
|
|
Bill Dna Probe 88271
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
8099070
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Aetna of IA Commercial |
$198.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
|
|
Bill Each Additonal Ab Per Slide 88341
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
7452803
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna of IA Commercial |
$190.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$190.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$159.00
|
| Rate for Payer: Medical Associates Commercial |
$159.00
|
| Rate for Payer: Midlands Choice Commercial |
$148.40
|
| Rate for Payer: United Healthcare Commercial |
$190.80
|
|
|
Bill Each Additonal Ab Per Slide 88341
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
7452803
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$105.96 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna of IA Commercial |
$190.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$190.80
|
| Rate for Payer: Aetna of IA Medicare |
$120.84
|
| Rate for Payer: Amerigroup Medicaid |
$107.00
|
| Rate for Payer: Amerigroup Medicare |
$107.06
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$159.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$106.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$105.96
|
| Rate for Payer: Medical Associates Commercial |
$159.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$106.00
|
| Rate for Payer: Midlands Choice Commercial |
$148.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$107.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$159.00
|
| Rate for Payer: United Healthcare Commercial |
$190.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$125.08
|
| Rate for Payer: Wellmark IA HMO |
$145.08
|
| Rate for Payer: Wellmark IA PPO |
$159.59
|
|
|
BILL ENZYME TREATMENT EA
|
Facility
IP
|
$101.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
8015154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna of IA Commercial |
$90.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.90
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.75
|
| Rate for Payer: Medical Associates Commercial |
$75.75
|
| Rate for Payer: Midlands Choice Commercial |
$70.70
|
| Rate for Payer: United Healthcare Commercial |
$90.90
|
|
|
BILL ENZYME TREATMENT EA
|
Facility
OP
|
$101.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
8015154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.48 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna of IA Commercial |
$90.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.90
|
| Rate for Payer: Aetna of IA Medicare |
$57.57
|
| Rate for Payer: Amerigroup Medicaid |
$50.97
|
| Rate for Payer: Amerigroup Medicare |
$51.00
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.48
|
| Rate for Payer: Medical Associates Commercial |
$75.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.50
|
| Rate for Payer: Midlands Choice Commercial |
$70.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.75
|
| Rate for Payer: United Healthcare Commercial |
$90.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.59
|
| Rate for Payer: Wellmark IA HMO |
$55.18
|
| Rate for Payer: Wellmark IA PPO |
$60.70
|
|
