|
BILL ANTIGEN SCREEN EACH UNIT
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
7829177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
|
|
BILL ANTIGEN SCREEN EACH UNIT
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86902
|
| Hospital Charge Code |
7829177
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$55.45 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.20
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.98
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
| Rate for Payer: Wellmark IA HMO WHPI |
$50.34
|
| Rate for Payer: Wellmark IA PPO |
$55.45
|
|
|
BILL ANTIGEN SCREEN W/ PT. PLASMA
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
7841884
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$55.45 |
| Rate for Payer: Aetna of IA Commercial |
$45.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.90
|
| Rate for Payer: Aetna of IA Medicare |
$29.07
|
| Rate for Payer: Amerigroup Medicaid |
$29.42
|
| Rate for Payer: Amerigroup Medicare |
$23.18
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.13
|
| Rate for Payer: Medical Associates Commercial |
$38.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.95
|
| Rate for Payer: Midlands Choice Commercial |
$35.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.39
|
| Rate for Payer: United Healthcare Commercial |
$45.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.09
|
| Rate for Payer: Wellmark IA HMO WHPI |
$50.34
|
| Rate for Payer: Wellmark IA PPO |
$55.45
|
|
|
BILL ANTIGEN SCREEN W/ PT. PLASMA
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86904
|
| Hospital Charge Code |
7841884
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna of IA Commercial |
$45.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.90
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.25
|
| Rate for Payer: Medical Associates Commercial |
$38.25
|
| Rate for Payer: Midlands Choice Commercial |
$35.70
|
| Rate for Payer: United Healthcare Commercial |
$45.90
|
|
|
BILL AUTOLOGOUS BLOOD EA
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 86890
|
| Hospital Charge Code |
8015151
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$79.10 |
| 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: Cash Price |
$90.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$84.75
|
| Rate for Payer: Medical Associates Commercial |
$84.75
|
| Rate for Payer: Midlands Choice Commercial |
$79.10
|
| Rate for Payer: United Healthcare Commercial |
$101.70
|
|
|
BILL AUTOLOGOUS BLOOD EA
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 86890
|
| Hospital Charge Code |
8015151
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$50.85 |
| Max. Negotiated Rate |
$215.56 |
| 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 |
$65.18
|
| Rate for Payer: Amerigroup Medicare |
$51.36
|
| 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 |
$50.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.55
|
| Rate for Payer: Medical Associates Commercial |
$84.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.85
|
| Rate for Payer: Midlands Choice Commercial |
$79.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.48
|
| Rate for Payer: United Healthcare Commercial |
$101.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$66.67
|
| Rate for Payer: Wellmark IA HMO WHPI |
$195.68
|
| Rate for Payer: Wellmark IA PPO |
$215.56
|
|
|
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 Cell Count 89051
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
8098792
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$33.30 |
| 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: Aetna of IA Medicare |
$42.18
|
| Rate for Payer: Amerigroup Medicaid |
$42.68
|
| Rate for Payer: Amerigroup Medicare |
$33.63
|
| 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 |
$33.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.27
|
| Rate for Payer: Medical Associates Commercial |
$55.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.30
|
| Rate for Payer: Midlands Choice Commercial |
$51.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.30
|
| Rate for Payer: United Healthcare Commercial |
$66.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.66
|
| Rate for Payer: Wellmark IA HMO WHPI |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
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 |
$33.30 |
| 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: Aetna of IA Medicare |
$42.18
|
| Rate for Payer: Amerigroup Medicaid |
$42.68
|
| Rate for Payer: Amerigroup Medicare |
$33.63
|
| 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 |
$33.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.27
|
| Rate for Payer: Medical Associates Commercial |
$55.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.30
|
| Rate for Payer: Midlands Choice Commercial |
$51.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.30
|
| Rate for Payer: United Healthcare Commercial |
$66.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.66
|
| Rate for Payer: Wellmark IA HMO WHPI |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
Bill Chromosome Analysis 88262
|
Facility
|
OP
|
$278.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
8099069
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$100.68 |
| 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 |
$160.35
|
| Rate for Payer: Amerigroup Medicare |
$126.35
|
| 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 |
$125.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$158.79
|
| Rate for Payer: Medical Associates Commercial |
$208.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$125.10
|
| Rate for Payer: Midlands Choice Commercial |
$194.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$161.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$143.86
|
| Rate for Payer: United Healthcare Commercial |
$250.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$164.02
|
| Rate for Payer: Wellmark IA HMO WHPI |
$100.68
|
| Rate for Payer: Wellmark IA PPO |
$110.90
|
|
|
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 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 |
$44.55 |
| Max. Negotiated Rate |
$153.86 |
| 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 |
$57.10
|
| Rate for Payer: Amerigroup Medicare |
$45.00
|
| 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 |
$44.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.55
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.55
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.23
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$139.67
|
| Rate for Payer: Wellmark IA PPO |
$153.86
|
|
|
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 Cytology Fluid 88104
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 88104
|
| Hospital Charge Code |
7452782
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$46.80 |
| 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: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$59.99
|
| Rate for Payer: Amerigroup Medicare |
$47.27
|
| 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 |
$46.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.40
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.80
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.82
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
| Rate for Payer: Wellmark IA HMO WHPI |
$68.06
|
| Rate for Payer: Wellmark IA PPO |
$74.98
|
|
|
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 |
$75.15 |
| 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 |
$96.33
|
| Rate for Payer: Amerigroup Medicare |
$75.90
|
| 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 |
$75.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$95.39
|
| Rate for Payer: Medical Associates Commercial |
$125.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$75.15
|
| Rate for Payer: Midlands Choice Commercial |
$116.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$96.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$86.42
|
| Rate for Payer: United Healthcare Commercial |
$150.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$98.53
|
| Rate for Payer: Wellmark IA HMO WHPI |
$80.12
|
| Rate for Payer: Wellmark IA PPO |
$88.25
|
|
|
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 |
$38.25 |
| 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 |
$49.03
|
| Rate for Payer: Amerigroup Medicare |
$38.63
|
| 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 |
$38.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.55
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.25
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.99
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.15
|
| Rate for Payer: Wellmark IA HMO WHPI |
$68.06
|
| Rate for Payer: Wellmark IA PPO |
$74.98
|
|
|
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 |
$47.25 |
| 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: Aetna of IA Medicare |
$59.85
|
| Rate for Payer: Amerigroup Medicaid |
$60.56
|
| Rate for Payer: Amerigroup Medicare |
$47.72
|
| 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 |
$47.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.98
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.25
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.34
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.95
|
| Rate for Payer: Wellmark IA HMO WHPI |
$68.06
|
| Rate for Payer: Wellmark IA PPO |
$74.98
|
|
|
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 |
$26.10 |
| Max. Negotiated Rate |
$55.45 |
| 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 |
$33.45
|
| Rate for Payer: Amerigroup Medicare |
$26.36
|
| 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 |
$26.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.13
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.10
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.02
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO WHPI |
$50.34
|
| Rate for Payer: Wellmark IA PPO |
$55.45
|
|
|
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
|
|
