|
Bill Dna Probe 88271
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
8099070
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$99.00 |
| 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: Aetna of IA Medicare |
$125.40
|
| Rate for Payer: Amerigroup Medicaid |
$126.90
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$125.66
|
| Rate for Payer: Medical Associates Commercial |
$165.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$154.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$127.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$113.85
|
| Rate for Payer: United Healthcare Commercial |
$198.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$129.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$100.68
|
| Rate for Payer: Wellmark IA PPO |
$110.90
|
|
|
Bill Each Additonal Ab Per Slide 88341
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
7452803
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$95.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna of IA Commercial |
$190.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$190.80
|
| Rate for Payer: Aetna of IA Medicare |
$120.84
|
| Rate for Payer: Amerigroup Medicaid |
$122.28
|
| Rate for Payer: Amerigroup Medicare |
$96.35
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$159.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$95.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$121.09
|
| Rate for Payer: Medical Associates Commercial |
$159.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.40
|
| Rate for Payer: Midlands Choice Commercial |
$148.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$122.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$109.71
|
| Rate for Payer: United Healthcare Commercial |
$190.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$125.08
|
| Rate for Payer: Wellmark IA HMO WHPI |
$98.55
|
| Rate for Payer: Wellmark IA PPO |
$108.56
|
|
|
Bill Each Additonal Ab Per Slide 88341
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
7452803
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$148.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna of IA Commercial |
$190.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$190.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$159.00
|
| Rate for Payer: Medical Associates Commercial |
$159.00
|
| Rate for Payer: Midlands Choice Commercial |
$148.40
|
| Rate for Payer: United Healthcare Commercial |
$190.80
|
|
|
BILL ENZYME TREATMENT EA
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
8015154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$70.70 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna of IA Commercial |
$90.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.90
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.75
|
| Rate for Payer: Medical Associates Commercial |
$75.75
|
| Rate for Payer: Midlands Choice Commercial |
$70.70
|
| Rate for Payer: United Healthcare Commercial |
$90.90
|
|
|
BILL ENZYME TREATMENT EA
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 86971
|
| Hospital Charge Code |
8015154
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna of IA Commercial |
$90.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.90
|
| Rate for Payer: Aetna of IA Medicare |
$57.57
|
| Rate for Payer: Amerigroup Medicaid |
$58.26
|
| Rate for Payer: Amerigroup Medicare |
$45.90
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$45.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.69
|
| Rate for Payer: Medical Associates Commercial |
$75.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.45
|
| Rate for Payer: Midlands Choice Commercial |
$70.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.27
|
| Rate for Payer: United Healthcare Commercial |
$90.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.59
|
| Rate for Payer: Wellmark IA HMO WHPI |
$195.68
|
| Rate for Payer: Wellmark IA PPO |
$215.56
|
|
|
Bill Fine Needle Aspirate 88172
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
8099075
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$181.19 |
| 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 |
$164.49
|
| Rate for Payer: Wellmark IA PPO |
$181.19
|
|
|
Bill Fine Needle Aspirate 88172
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
8099075
|
|
Hospital Revenue Code
|
311
|
| 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 Flow Cytometry 9-15 Markers 88188
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 88188
|
| Hospital Charge Code |
8099059
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Aetna of IA Commercial |
$122.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$122.40
|
| Rate for Payer: Aetna of IA Medicare |
$77.52
|
| Rate for Payer: Amerigroup Medicaid |
$78.44
|
| Rate for Payer: Amerigroup Medicare |
$61.81
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.68
|
| Rate for Payer: Medical Associates Commercial |
$102.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.20
|
| Rate for Payer: Midlands Choice Commercial |
$95.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$78.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$70.38
|
| Rate for Payer: United Healthcare Commercial |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$80.24
|
| Rate for Payer: Wellmark IA HMO WHPI |
$68.06
|
| Rate for Payer: Wellmark IA PPO |
$74.98
|
|
|
Bill Flow Cytometry 9-15 Markers 88188
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 88188
|
| Hospital Charge Code |
8099059
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Aetna of IA Commercial |
$122.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$122.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.00
|
| Rate for Payer: Medical Associates Commercial |
$102.00
|
| Rate for Payer: Midlands Choice Commercial |
$95.20
|
| Rate for Payer: United Healthcare Commercial |
$122.40
|
|
|
Bill Flow Cytometry Marker 1st 88184
|
Facility
|
OP
|
$215.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
8099057
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$96.75 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Aetna of IA Medicare |
$122.55
|
| Rate for Payer: Amerigroup Medicaid |
$124.01
|
| Rate for Payer: Amerigroup Medicare |
$97.72
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$96.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$122.81
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$124.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.26
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$126.85
|
| Rate for Payer: Wellmark IA HMO WHPI |
$164.49
|
| Rate for Payer: Wellmark IA PPO |
$181.19
|
|
|
Bill Flow Cytometry Marker 1st 88184
|
Facility
|
IP
|
$215.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
8099057
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$193.50 |
| Rate for Payer: Aetna of IA Commercial |
$193.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$193.50
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$161.25
|
| Rate for Payer: Medical Associates Commercial |
$161.25
|
| Rate for Payer: Midlands Choice Commercial |
$150.50
|
| Rate for Payer: United Healthcare Commercial |
$193.50
|
|
|
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 |
$51.75 |
| 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 |
$66.33
|
| Rate for Payer: Amerigroup Medicare |
$52.27
|
| 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 |
$51.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.69
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.75
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.51
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.85
|
| Rate for Payer: Wellmark IA HMO WHPI |
$68.06
|
| Rate for Payer: Wellmark IA PPO |
$74.98
|
|
|
Bill Flow Cytometry Marker 1st 88189
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 88189
|
| Hospital Charge Code |
8099060
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$80.50 |
| 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: Cash Price |
$92.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.25
|
| Rate for Payer: Medical Associates Commercial |
$86.25
|
| Rate for Payer: Midlands Choice Commercial |
$80.50
|
| Rate for Payer: United Healthcare Commercial |
$103.50
|
|
|
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 |
$65.25 |
| 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: Aetna of IA Medicare |
$82.65
|
| Rate for Payer: Amerigroup Medicaid |
$83.64
|
| Rate for Payer: Amerigroup Medicare |
$65.90
|
| 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 |
$65.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$82.82
|
| Rate for Payer: Medical Associates Commercial |
$108.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.25
|
| Rate for Payer: Midlands Choice Commercial |
$101.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$84.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.04
|
| Rate for Payer: United Healthcare Commercial |
$130.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$85.55
|
| Rate for Payer: Wellmark IA HMO WHPI |
$68.06
|
| Rate for Payer: Wellmark IA PPO |
$74.98
|
|
|
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 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 |
$81.90 |
| Max. Negotiated Rate |
$270.23 |
| 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 |
$104.98
|
| Rate for Payer: Amerigroup Medicare |
$82.72
|
| 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 |
$81.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.96
|
| Rate for Payer: Medical Associates Commercial |
$136.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.90
|
| Rate for Payer: Midlands Choice Commercial |
$127.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$105.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$94.18
|
| Rate for Payer: United Healthcare Commercial |
$163.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$107.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$245.31
|
| Rate for Payer: Wellmark IA PPO |
$270.23
|
|
|
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 |
$152.55 |
| 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 |
$195.54
|
| Rate for Payer: Amerigroup Medicare |
$154.08
|
| 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 |
$152.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$193.64
|
| Rate for Payer: Medical Associates Commercial |
$254.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$152.55
|
| Rate for Payer: Midlands Choice Commercial |
$237.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$196.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$175.43
|
| Rate for Payer: United Healthcare Commercial |
$305.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$200.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$245.31
|
| Rate for Payer: Wellmark IA PPO |
$270.23
|
|
|
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 |
$100.68 |
| 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 |
$157.47
|
| Rate for Payer: Amerigroup Medicare |
$124.08
|
| 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 |
$122.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$155.94
|
| Rate for Payer: Medical Associates Commercial |
$204.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$122.85
|
| Rate for Payer: Midlands Choice Commercial |
$191.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$158.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.28
|
| Rate for Payer: United Healthcare Commercial |
$245.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$161.07
|
| Rate for Payer: Wellmark IA HMO WHPI |
$100.68
|
| Rate for Payer: Wellmark IA PPO |
$110.90
|
|
|
Bill Pap Smear, Thin prep
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS G0123
|
| Hospital Charge Code |
7845597
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.50 |
| 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 |
$63.45
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| 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 |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.83
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.92
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
| Rate for Payer: Wellmark IA HMO WHPI |
$51.76
|
| Rate for Payer: Wellmark IA PPO |
$57.01
|
|
|
Bill Pap Smear, Thin prep
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS 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
|
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 1st Tissue 88331
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
7452796
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$88.25 |
| 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 |
$56.53
|
| Rate for Payer: Amerigroup Medicare |
$44.54
|
| 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 |
$44.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.98
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.10
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.72
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Wellmark IA HMO WHPI |
$80.12
|
| Rate for Payer: Wellmark IA PPO |
$88.25
|
|
