|
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: 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: 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
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: 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 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 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: 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
|
|
|
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 5
|
Facility
OP
|
$312.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
7830820
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$145.08 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna of IA Commercial |
$280.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$280.80
|
| Rate for Payer: Aetna of IA Medicare |
$177.84
|
| Rate for Payer: Amerigroup Medicaid |
$157.47
|
| Rate for Payer: Amerigroup Medicare |
$157.56
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$234.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$156.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$155.94
|
| Rate for Payer: Medical Associates Commercial |
$234.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$156.00
|
| Rate for Payer: Midlands Choice Commercial |
$218.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$158.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$234.00
|
| Rate for Payer: United Healthcare Commercial |
$280.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$184.08
|
| Rate for Payer: Wellmark IA HMO |
$145.08
|
| Rate for Payer: Wellmark IA PPO |
$159.59
|
|
|
Bill Path Level 5
|
Facility
IP
|
$312.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
7830820
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Aetna of IA Commercial |
$280.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$280.80
|
| Rate for Payer: Cash Price |
$249.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$234.00
|
| Rate for Payer: Medical Associates Commercial |
$234.00
|
| Rate for Payer: Midlands Choice Commercial |
$218.40
|
| Rate for Payer: United Healthcare Commercial |
$280.80
|
|
|
Bill Path Level 6
|
Facility
IP
|
$406.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
7830821
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna of IA Commercial |
$365.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$365.40
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$304.50
|
| Rate for Payer: Medical Associates Commercial |
$304.50
|
| Rate for Payer: Midlands Choice Commercial |
$284.20
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
|
|
Bill Path Level 6
|
Facility
OP
|
$406.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
7830821
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$145.08 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Aetna of IA Commercial |
$365.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$365.40
|
| Rate for Payer: Aetna of IA Medicare |
$231.42
|
| Rate for Payer: Amerigroup Medicaid |
$204.91
|
| Rate for Payer: Amerigroup Medicare |
$205.03
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$304.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$203.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.92
|
| Rate for Payer: Medical Associates Commercial |
$304.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$203.00
|
| Rate for Payer: Midlands Choice Commercial |
$284.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$206.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$304.50
|
| Rate for Payer: United Healthcare Commercial |
$365.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$239.54
|
| Rate for Payer: Wellmark IA HMO |
$145.08
|
| Rate for Payer: Wellmark IA PPO |
$159.59
|
|
|
BILL RH PHENOTYPING
|
Facility
IP
|
$52.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
7829180
|
|
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 RH PHENOTYPING
|
Facility
OP
|
$52.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
7829180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.99 |
| 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: 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 |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Bill Semen Analysis With Strict Morphology 89322
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 89322
|
| Hospital Charge Code |
8098796
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$61.38 |
| 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 |
$61.38
|
| Rate for Payer: Wellmark IA PPO |
$67.52
|
|
|
Bill Semen Analysis With Strict Morphology 89322
|
Facility
OP
|
$278.00
|
|
|
Service Code
|
CPT 89322
|
| Hospital Charge Code |
8053744
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$61.38 |
| 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 |
$61.38
|
| Rate for Payer: Wellmark IA PPO |
$67.52
|
|
|
Bill Semen Analysis With Strict Morphology 89322
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 89322
|
| Hospital Charge Code |
8053744
|
|
Hospital Revenue Code
|
309
|
| 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 Semen Analysis With Strict Morphology 89322
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 89322
|
| Hospital Charge Code |
8098796
|
|
Hospital Revenue Code
|
309
|
| 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 Semen Vasectomy 89321
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
8098795
|
|
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 Semen Vasectomy 89321
|
Facility
IP
|
$74.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
8098795
|
|
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 Special Stains, Group I 88312
|
Facility
IP
|
$169.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
7452792
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$118.30 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna of IA Commercial |
$152.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$152.10
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$126.75
|
| Rate for Payer: Medical Associates Commercial |
$126.75
|
| Rate for Payer: Midlands Choice Commercial |
$118.30
|
| Rate for Payer: United Healthcare Commercial |
$152.10
|
|
|
Bill Special Stains, Group I 88312
|
Facility
OP
|
$169.00
|
|
|
Service Code
|
CPT 88312
|
| Hospital Charge Code |
7452792
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$84.47 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna of IA Commercial |
$152.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$152.10
|
| Rate for Payer: Aetna of IA Medicare |
$96.33
|
| Rate for Payer: Amerigroup Medicaid |
$85.29
|
| Rate for Payer: Amerigroup Medicare |
$85.34
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$126.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$84.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$84.47
|
| Rate for Payer: Medical Associates Commercial |
$126.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$84.50
|
| Rate for Payer: Midlands Choice Commercial |
$118.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$85.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$126.75
|
| Rate for Payer: United Healthcare Commercial |
$152.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$99.71
|
| Rate for Payer: Wellmark IA HMO |
$112.84
|
| Rate for Payer: Wellmark IA PPO |
$124.12
|
|
|
Bill Special Stains, Group II 88313
|
Facility
OP
|
$132.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
7452793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna of IA Commercial |
$118.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$118.80
|
| Rate for Payer: Aetna of IA Medicare |
$75.24
|
| Rate for Payer: Amerigroup Medicaid |
$66.62
|
| Rate for Payer: Amerigroup Medicare |
$66.66
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$66.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.97
|
| Rate for Payer: Medical Associates Commercial |
$99.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$66.00
|
| Rate for Payer: Midlands Choice Commercial |
$92.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$99.00
|
| Rate for Payer: United Healthcare Commercial |
$118.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$77.88
|
| Rate for Payer: Wellmark IA HMO |
$61.38
|
| Rate for Payer: Wellmark IA PPO |
$67.52
|
|
|
Bill Special Stains, Group II 88313
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
7452793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna of IA Commercial |
$118.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$118.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.00
|
| Rate for Payer: Medical Associates Commercial |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$118.80
|
|
|
Bill Tissue Culture 88233
|
Facility
OP
|
$403.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
8099068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$145.08 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Aetna of IA Commercial |
$362.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$362.70
|
| Rate for Payer: Aetna of IA Medicare |
$229.71
|
| Rate for Payer: Amerigroup Medicaid |
$203.39
|
| Rate for Payer: Amerigroup Medicare |
$203.52
|
| Rate for Payer: Cash Price |
$322.40
|
| Rate for Payer: Cash Price |
$322.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$302.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$201.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$201.42
|
| Rate for Payer: Medical Associates Commercial |
$302.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$201.50
|
| Rate for Payer: Midlands Choice Commercial |
$282.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$204.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$302.25
|
| Rate for Payer: United Healthcare Commercial |
$362.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$237.77
|
| Rate for Payer: Wellmark IA HMO |
$145.08
|
| Rate for Payer: Wellmark IA PPO |
$159.59
|
|
|
Bill Tissue Culture 88233
|
Facility
IP
|
$403.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
8099068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$282.10 |
| Max. Negotiated Rate |
$362.70 |
| Rate for Payer: Aetna of IA Commercial |
$362.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$362.70
|
| Rate for Payer: Cash Price |
$322.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$302.25
|
| Rate for Payer: Medical Associates Commercial |
$302.25
|
| Rate for Payer: Midlands Choice Commercial |
$282.10
|
| Rate for Payer: United Healthcare Commercial |
$362.70
|
|
