|
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 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: Molina Healthcare Managed Medicare |
$158.25
|
| Rate for Payer: Oscar Health of IA Commercial |
$234.00
|
| 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 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: Molina Healthcare Managed Medicare |
$205.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$304.50
|
| 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 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 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: Molina Healthcare Managed Medicare |
$26.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$39.00
|
| 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
|
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 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: Molina Healthcare Managed Medicare |
$141.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$208.50
|
| 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
|
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: Molina Healthcare Managed Medicare |
$141.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$208.50
|
| 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 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 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: 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 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: Molina Healthcare Managed Medicare |
$85.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$126.75
|
| 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 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 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: Molina Healthcare Managed Medicare |
$66.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$99.00
|
| 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
|
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
|
|
|
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: Molina Healthcare Managed Medicare |
$204.40
|
| Rate for Payer: Oscar Health of IA Commercial |
$302.25
|
| 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 Chromosome 88230
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
8099061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$145.08 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna of IA Commercial |
$428.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$428.40
|
| Rate for Payer: Aetna of IA Medicare |
$271.32
|
| Rate for Payer: Amerigroup Medicaid |
$240.24
|
| Rate for Payer: Amerigroup Medicare |
$240.38
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$357.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$238.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$237.90
|
| Rate for Payer: Medical Associates Commercial |
$357.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$238.00
|
| Rate for Payer: Midlands Choice Commercial |
$333.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$241.57
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$241.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$357.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$357.00
|
| Rate for Payer: United Healthcare Commercial |
$428.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$280.84
|
| Rate for Payer: Wellmark IA HMO |
$145.08
|
| Rate for Payer: Wellmark IA PPO |
$159.59
|
|
|
Bill Tissue Culture Chromosome 88230
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
8099061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Aetna of IA Commercial |
$428.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$428.40
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$357.00
|
| Rate for Payer: Medical Associates Commercial |
$357.00
|
| Rate for Payer: Midlands Choice Commercial |
$333.20
|
| Rate for Payer: United Healthcare Commercial |
$428.40
|
|
|
Bill Tmr Ihc P/Spec Ea Ab Stain 88360
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
7452805
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$125.30 |
| Max. Negotiated Rate |
$161.10 |
| Rate for Payer: Aetna of IA Commercial |
$161.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$161.10
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$134.25
|
| Rate for Payer: Medical Associates Commercial |
$134.25
|
| Rate for Payer: Midlands Choice Commercial |
$125.30
|
| Rate for Payer: United Healthcare Commercial |
$161.10
|
|
|
Bill Tmr Ihc P/Spec Ea Ab Stain 88360
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
7452805
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$89.46 |
| Max. Negotiated Rate |
$161.10 |
| Rate for Payer: Aetna of IA Commercial |
$161.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$161.10
|
| Rate for Payer: Aetna of IA Medicare |
$102.03
|
| Rate for Payer: Amerigroup Medicaid |
$90.34
|
| Rate for Payer: Amerigroup Medicare |
$90.40
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$134.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.46
|
| Rate for Payer: Medical Associates Commercial |
$134.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.50
|
| Rate for Payer: Midlands Choice Commercial |
$125.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$90.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$134.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$134.25
|
| Rate for Payer: United Healthcare Commercial |
$161.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$105.61
|
| Rate for Payer: Wellmark IA HMO |
$145.08
|
| Rate for Payer: Wellmark IA PPO |
$159.59
|
|
|
Bill Touch Prep Site Cytologic Initial 88333
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
8098790
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$124.12 |
| Rate for Payer: Aetna of IA Commercial |
$74.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.70
|
| Rate for Payer: Aetna of IA Medicare |
$47.31
|
| Rate for Payer: Amerigroup Medicaid |
$41.89
|
| Rate for Payer: Amerigroup Medicare |
$41.92
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.48
|
| Rate for Payer: Medical Associates Commercial |
$62.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.50
|
| Rate for Payer: Midlands Choice Commercial |
$58.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.12
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$42.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$62.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$62.25
|
| Rate for Payer: United Healthcare Commercial |
$74.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.97
|
| Rate for Payer: Wellmark IA HMO |
$112.84
|
| Rate for Payer: Wellmark IA PPO |
$124.12
|
|
|
Bill Touch Prep Site Cytologic Initial 88333
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 88333
|
| Hospital Charge Code |
8098790
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna of IA Commercial |
$74.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.70
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.25
|
| Rate for Payer: Medical Associates Commercial |
$62.25
|
| Rate for Payer: Midlands Choice Commercial |
$58.10
|
| Rate for Payer: United Healthcare Commercial |
$74.70
|
|
|
Bill UA Auto with Micro
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
7813898
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna of IA Commercial |
$27.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.90
|
| Rate for Payer: Aetna of IA Medicare |
$17.67
|
| Rate for Payer: Amerigroup Medicaid |
$15.65
|
| Rate for Payer: Amerigroup Medicare |
$15.66
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.49
|
| Rate for Payer: Medical Associates Commercial |
$23.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.50
|
| Rate for Payer: Midlands Choice Commercial |
$21.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$15.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$23.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.25
|
| Rate for Payer: United Healthcare Commercial |
$27.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.29
|
| Rate for Payer: Wellmark IA HMO |
$22.32
|
| Rate for Payer: Wellmark IA PPO |
$24.55
|
|
