|
Bill Flow Cytometry Marker 1st 88189
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 88189
|
| Hospital Charge Code |
8099060
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Aetna of IA Commercial |
$103.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.50
|
| Rate for Payer: Aetna of IA Medicare |
$65.55
|
| Rate for Payer: Amerigroup Medicaid |
$58.04
|
| Rate for Payer: Amerigroup Medicare |
$58.08
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.48
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.50
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58.36
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$58.33
|
| Rate for Payer: Oscar Health of IA Commercial |
$86.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$86.25
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.85
|
| Rate for Payer: Wellmark IA HMO |
$61.38
|
| Rate for Payer: Wellmark IA PPO |
$67.52
|
|
|
Bill Flow Cytometry Marker Additional 88185
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
8099058
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$101.50 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna of IA Commercial |
$130.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$130.50
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.75
|
| Rate for Payer: Medical Associates Commercial |
$108.75
|
| Rate for Payer: Midlands Choice Commercial |
$101.50
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
|
|
Bill Flow Cytometry Marker Additional 88185
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
8099058
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$72.47 |
| Max. Negotiated Rate |
$159.59 |
| Rate for Payer: Aetna of IA Commercial |
$130.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$130.50
|
| Rate for Payer: Aetna of IA Medicare |
$82.65
|
| Rate for Payer: Amerigroup Medicaid |
$73.18
|
| Rate for Payer: Amerigroup Medicare |
$73.22
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$108.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$72.47
|
| Rate for Payer: Medical Associates Commercial |
$108.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.50
|
| Rate for Payer: Midlands Choice Commercial |
$101.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.59
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$73.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$108.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$108.75
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$85.55
|
| Rate for Payer: Wellmark IA HMO |
$145.08
|
| Rate for Payer: Wellmark IA PPO |
$159.59
|
|
|
Bill Immunohist, Each Anitbody 88342
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
7452798
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna of IA Commercial |
$163.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$163.80
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$136.50
|
| Rate for Payer: Medical Associates Commercial |
$136.50
|
| Rate for Payer: Midlands Choice Commercial |
$127.40
|
| Rate for Payer: United Healthcare Commercial |
$163.80
|
|
|
Bill Immunohist, Each Anitbody 88342
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
7452798
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.96 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna of IA Commercial |
$163.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$163.80
|
| Rate for Payer: Aetna of IA Medicare |
$103.74
|
| Rate for Payer: Amerigroup Medicaid |
$91.86
|
| Rate for Payer: Amerigroup Medicare |
$91.91
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$136.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$91.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.96
|
| Rate for Payer: Medical Associates Commercial |
$136.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$91.00
|
| Rate for Payer: Midlands Choice Commercial |
$127.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.36
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$92.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$136.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$136.50
|
| Rate for Payer: United Healthcare Commercial |
$163.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$107.38
|
| Rate for Payer: Wellmark IA HMO |
$112.84
|
| Rate for Payer: Wellmark IA PPO |
$124.12
|
|
|
Bill In Situ Hybrid Manual 88368
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
8098791
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$145.08 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Aetna of IA Commercial |
$305.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$305.10
|
| Rate for Payer: Aetna of IA Medicare |
$193.23
|
| Rate for Payer: Amerigroup Medicaid |
$171.09
|
| Rate for Payer: Amerigroup Medicare |
$171.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$254.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$169.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$169.43
|
| Rate for Payer: Medical Associates Commercial |
$254.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$169.50
|
| Rate for Payer: Midlands Choice Commercial |
$237.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$172.04
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$171.94
|
| Rate for Payer: Oscar Health of IA Commercial |
$254.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$254.25
|
| Rate for Payer: United Healthcare Commercial |
$305.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$200.01
|
| Rate for Payer: Wellmark IA HMO |
$145.08
|
| Rate for Payer: Wellmark IA PPO |
$159.59
|
|
|
Bill In Situ Hybrid Manual 88368
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 88368
|
| Hospital Charge Code |
8098791
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$237.30 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Aetna of IA Commercial |
$305.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$305.10
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$254.25
|
| Rate for Payer: Medical Associates Commercial |
$254.25
|
| Rate for Payer: Midlands Choice Commercial |
$237.30
|
| Rate for Payer: United Healthcare Commercial |
$305.10
|
|
|
Bill Interphase Hybridization 88275
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
8099071
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Aetna of IA Commercial |
$245.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$245.70
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$204.75
|
| Rate for Payer: Medical Associates Commercial |
$204.75
|
| Rate for Payer: Midlands Choice Commercial |
$191.10
|
| Rate for Payer: United Healthcare Commercial |
$245.70
|
|
|
Bill Interphase Hybridization 88275
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
8099071
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$136.45 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Aetna of IA Commercial |
$245.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$245.70
|
| Rate for Payer: Aetna of IA Medicare |
$155.61
|
| Rate for Payer: Amerigroup Medicaid |
$137.78
|
| Rate for Payer: Amerigroup Medicare |
$137.86
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$204.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$136.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$136.45
|
| Rate for Payer: Medical Associates Commercial |
$204.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$136.50
|
| Rate for Payer: Midlands Choice Commercial |
$191.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$138.55
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$138.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$204.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$204.75
|
| Rate for Payer: United Healthcare Commercial |
$245.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$161.07
|
| Rate for Payer: Wellmark IA HMO |
$143.22
|
| Rate for Payer: Wellmark IA PPO |
$157.54
|
|
|
Bill Interpretation Chromosome 88291
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
8099072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$251.30 |
| Max. Negotiated Rate |
$323.10 |
| Rate for Payer: Aetna of IA Commercial |
$323.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$323.10
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$269.25
|
| Rate for Payer: Medical Associates Commercial |
$269.25
|
| Rate for Payer: Midlands Choice Commercial |
$251.30
|
| Rate for Payer: United Healthcare Commercial |
$323.10
|
|
|
Bill Interpretation Chromosome 88291
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
8099072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$143.22 |
| Max. Negotiated Rate |
$323.10 |
| Rate for Payer: Aetna of IA Commercial |
$323.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$323.10
|
| Rate for Payer: Aetna of IA Medicare |
$204.63
|
| Rate for Payer: Amerigroup Medicaid |
$181.19
|
| Rate for Payer: Amerigroup Medicare |
$181.30
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$269.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$179.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.43
|
| Rate for Payer: Medical Associates Commercial |
$269.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$179.50
|
| Rate for Payer: Midlands Choice Commercial |
$251.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$182.19
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$182.08
|
| Rate for Payer: Oscar Health of IA Commercial |
$269.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$269.25
|
| Rate for Payer: United Healthcare Commercial |
$323.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$211.81
|
| Rate for Payer: Wellmark IA HMO |
$143.22
|
| Rate for Payer: Wellmark IA PPO |
$157.54
|
|
|
Bill Pap Smear, Thin prep
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT G0123
|
| Hospital Charge Code |
7845597
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$55.52
|
| Rate for Payer: Amerigroup Medicare |
$55.55
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.98
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.00
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$55.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$82.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Bill Pap Smear, Thin prep
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT G0123
|
| Hospital Charge Code |
7845597
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
Bill Path Consult 1st Tissue 88331
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
7452796
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$48.98 |
| Max. Negotiated Rate |
$159.59 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Aetna of IA Medicare |
$55.86
|
| Rate for Payer: Amerigroup Medicaid |
$49.46
|
| Rate for Payer: Amerigroup Medicare |
$49.49
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.98
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.00
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.74
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$49.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$73.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$73.50
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Wellmark IA HMO |
$145.08
|
| Rate for Payer: Wellmark IA PPO |
$159.59
|
|
|
Bill Path Consult 1st Tissue 88331
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
7452796
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
|
|
Bill Path Consult Each Addl 88332
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
7452797
|
|
Hospital Revenue Code
|
310
|
| 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 Path Consult Each Addl 88332
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
7452797
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$124.12 |
| 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: Molina Healthcare Managed Medicare |
$37.53
|
| Rate for Payer: Oscar Health of IA Commercial |
$55.50
|
| 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 |
$112.84
|
| Rate for Payer: Wellmark IA PPO |
$124.12
|
|
|
Bill Path Decalcification
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
7830775
|
|
Hospital Revenue Code
|
310
|
| 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 Path Decalcification
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
7830775
|
|
Hospital Revenue Code
|
310
|
| 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: Molina Healthcare Managed Medicare |
$37.53
|
| Rate for Payer: Oscar Health of IA Commercial |
$55.50
|
| 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 Path Gross Only
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
7830789
|
|
Hospital Revenue Code
|
310
|
| 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 Path Gross Only
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
7830789
|
|
Hospital Revenue Code
|
310
|
| 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: Molina Healthcare Managed Medicare |
$37.53
|
| Rate for Payer: Oscar Health of IA Commercial |
$55.50
|
| 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 Path Level 2
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
7830797
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of IA Commercial |
$104.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$104.40
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.00
|
| Rate for Payer: Medical Associates Commercial |
$87.00
|
| Rate for Payer: Midlands Choice Commercial |
$81.20
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
|
|
Bill Path Level 2
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
7830797
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$57.98 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Aetna of IA Commercial |
$104.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$104.40
|
| Rate for Payer: Aetna of IA Medicare |
$66.12
|
| Rate for Payer: Amerigroup Medicaid |
$58.55
|
| Rate for Payer: Amerigroup Medicare |
$58.58
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.98
|
| Rate for Payer: Medical Associates Commercial |
$87.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.00
|
| Rate for Payer: Midlands Choice Commercial |
$81.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58.87
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$58.84
|
| Rate for Payer: Oscar Health of IA Commercial |
$87.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$68.44
|
| Rate for Payer: Wellmark IA HMO |
$61.38
|
| Rate for Payer: Wellmark IA PPO |
$67.52
|
|
|
Bill Path Level 3
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
7830805
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna of IA Commercial |
$113.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$113.40
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$94.50
|
| Rate for Payer: Medical Associates Commercial |
$94.50
|
| Rate for Payer: Midlands Choice Commercial |
$88.20
|
| Rate for Payer: United Healthcare Commercial |
$113.40
|
|
|
Bill Path Level 3
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
7830805
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$62.97 |
| Max. Negotiated Rate |
$124.12 |
| Rate for Payer: Aetna of IA Commercial |
$113.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$113.40
|
| Rate for Payer: Aetna of IA Medicare |
$71.82
|
| Rate for Payer: Amerigroup Medicaid |
$63.59
|
| Rate for Payer: Amerigroup Medicare |
$63.63
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$94.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$63.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.97
|
| Rate for Payer: Medical Associates Commercial |
$94.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.00
|
| Rate for Payer: Midlands Choice Commercial |
$88.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.94
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$63.91
|
| Rate for Payer: Oscar Health of IA Commercial |
$94.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$113.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.34
|
| Rate for Payer: Wellmark IA HMO |
$112.84
|
| Rate for Payer: Wellmark IA PPO |
$124.12
|
|
