|
Bill Path Consult Each Addl 88332
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
7452797
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$88.25 |
| 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 |
$80.12
|
| Rate for Payer: Wellmark IA PPO |
$88.25
|
|
|
Bill Path Consult Each Addl 88332
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 88332
|
| Hospital Charge Code |
7452797
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna of IA Commercial |
$66.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.60
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.50
|
| Rate for Payer: Medical Associates Commercial |
$55.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.80
|
| Rate for Payer: United Healthcare Commercial |
$66.60
|
|
|
Bill Path Decalcification
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
7830775
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$108.56 |
| 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 |
$98.55
|
| Rate for Payer: Wellmark IA PPO |
$108.56
|
|
|
Bill Path Decalcification
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 88311
|
| Hospital Charge Code |
7830775
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna of IA Commercial |
$66.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.60
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.50
|
| Rate for Payer: Medical Associates Commercial |
$55.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.80
|
| Rate for Payer: United Healthcare Commercial |
$66.60
|
|
|
Bill Path 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 |
$33.30 |
| Max. Negotiated Rate |
$108.56 |
| 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 |
$98.55
|
| Rate for Payer: Wellmark IA PPO |
$108.56
|
|
|
Bill Path Level 2
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
7830797
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$108.56 |
| 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 |
$66.91
|
| Rate for Payer: Amerigroup Medicare |
$52.72
|
| 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 |
$52.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.26
|
| Rate for Payer: Medical Associates Commercial |
$87.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.20
|
| Rate for Payer: Midlands Choice Commercial |
$81.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$67.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.03
|
| Rate for Payer: United Healthcare Commercial |
$104.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$68.44
|
| Rate for Payer: Wellmark IA HMO WHPI |
$98.55
|
| Rate for Payer: Wellmark IA PPO |
$108.56
|
|
|
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
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
7830805
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna of IA Commercial |
$113.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$113.40
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$94.50
|
| Rate for Payer: Medical Associates Commercial |
$94.50
|
| Rate for Payer: Midlands Choice Commercial |
$88.20
|
| Rate for Payer: United Healthcare Commercial |
$113.40
|
|
|
Bill Path Level 3
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
7830805
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$56.70 |
| 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: Aetna of IA Medicare |
$71.82
|
| Rate for Payer: Amerigroup Medicaid |
$72.68
|
| Rate for Payer: Amerigroup Medicare |
$57.27
|
| 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 |
$56.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.97
|
| Rate for Payer: Medical Associates Commercial |
$94.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.70
|
| Rate for Payer: Midlands Choice Commercial |
$88.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$65.20
|
| Rate for Payer: United Healthcare Commercial |
$113.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.34
|
| Rate for Payer: Wellmark IA HMO WHPI |
$98.55
|
| Rate for Payer: Wellmark IA PPO |
$108.56
|
|
|
Bill Path Level 4
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
7830811
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
|
|
Bill Path Level 4
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
7830811
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$71.55 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Aetna of IA Commercial |
$143.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$143.10
|
| Rate for Payer: Aetna of IA Medicare |
$90.63
|
| Rate for Payer: Amerigroup Medicaid |
$91.71
|
| Rate for Payer: Amerigroup Medicare |
$72.27
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$119.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$71.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.82
|
| Rate for Payer: Medical Associates Commercial |
$119.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.55
|
| Rate for Payer: Midlands Choice Commercial |
$111.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.28
|
| Rate for Payer: United Healthcare Commercial |
$143.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$93.81
|
| Rate for Payer: Wellmark IA HMO WHPI |
$98.55
|
| Rate for Payer: Wellmark IA PPO |
$108.56
|
|
|
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 |
$140.40 |
| 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: Aetna of IA Medicare |
$177.84
|
| Rate for Payer: Amerigroup Medicaid |
$179.96
|
| Rate for Payer: Amerigroup Medicare |
$141.80
|
| 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 |
$140.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$178.21
|
| Rate for Payer: Medical Associates Commercial |
$234.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$140.40
|
| Rate for Payer: Midlands Choice Commercial |
$218.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$180.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$161.46
|
| Rate for Payer: United Healthcare Commercial |
$280.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$184.08
|
| Rate for Payer: Wellmark IA HMO WHPI |
$245.31
|
| Rate for Payer: Wellmark IA PPO |
$270.23
|
|
|
BILL RH PHENOTYPING
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
7829180
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$55.45 |
| 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 |
$29.99
|
| Rate for Payer: Amerigroup Medicare |
$23.63
|
| 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 |
$23.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.70
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.40
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.91
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
| Rate for Payer: Wellmark IA HMO WHPI |
$50.34
|
| Rate for Payer: Wellmark IA PPO |
$55.45
|
|
|
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 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 |
$49.63 |
| 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 |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
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 |
8053744
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.63 |
| 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 |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
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 |
$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 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 |
$76.05 |
| 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 |
$97.48
|
| Rate for Payer: Amerigroup Medicare |
$76.81
|
| 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 |
$76.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$96.53
|
| Rate for Payer: Medical Associates Commercial |
$126.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.05
|
| Rate for Payer: Midlands Choice Commercial |
$118.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$97.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.46
|
| Rate for Payer: United Healthcare Commercial |
$152.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$99.71
|
| Rate for Payer: Wellmark IA HMO WHPI |
$98.55
|
| Rate for Payer: Wellmark IA PPO |
$108.56
|
|
|
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
|
|
