|
Bill Special Stains, Group II 88313
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
7452793
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Aetna of IA Commercial |
$118.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$118.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$99.00
|
| Rate for Payer: Medical Associates Commercial |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$92.40
|
| Rate for Payer: United Healthcare Commercial |
$118.80
|
|
|
Bill Tissue Culture 88233
|
Facility
|
OP
|
$403.00
|
|
|
Service Code
|
CPT 88233
|
| Hospital Charge Code |
8099068
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$164.49 |
| 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 |
$232.45
|
| Rate for Payer: Amerigroup Medicare |
$183.16
|
| 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 |
$181.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$230.19
|
| Rate for Payer: Medical Associates Commercial |
$302.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$181.35
|
| Rate for Payer: Midlands Choice Commercial |
$282.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$233.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$208.55
|
| Rate for Payer: United Healthcare Commercial |
$362.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$237.77
|
| Rate for Payer: Wellmark IA HMO WHPI |
$164.49
|
| Rate for Payer: Wellmark IA PPO |
$181.19
|
|
|
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 Chromosome 88230
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
8099061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$164.49 |
| 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 |
$274.56
|
| Rate for Payer: Amerigroup Medicare |
$216.34
|
| 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 |
$214.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$271.89
|
| Rate for Payer: Medical Associates Commercial |
$357.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$214.20
|
| Rate for Payer: Midlands Choice Commercial |
$333.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$275.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$246.33
|
| Rate for Payer: United Healthcare Commercial |
$428.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$280.84
|
| Rate for Payer: Wellmark IA HMO WHPI |
$164.49
|
| Rate for Payer: Wellmark IA PPO |
$181.19
|
|
|
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
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
7452805
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.55 |
| Max. Negotiated Rate |
$270.23 |
| 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 |
$103.25
|
| Rate for Payer: Amerigroup Medicare |
$81.36
|
| 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 |
$80.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$102.24
|
| Rate for Payer: Medical Associates Commercial |
$134.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.55
|
| Rate for Payer: Midlands Choice Commercial |
$125.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$103.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$92.63
|
| Rate for Payer: United Healthcare Commercial |
$161.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$105.61
|
| Rate for Payer: Wellmark IA HMO WHPI |
$245.31
|
| Rate for Payer: Wellmark IA PPO |
$270.23
|
|
|
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 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 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 |
$37.35 |
| Max. Negotiated Rate |
$88.25 |
| 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 |
$47.87
|
| Rate for Payer: Amerigroup Medicare |
$37.72
|
| 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 |
$37.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.41
|
| Rate for Payer: Medical Associates Commercial |
$62.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.35
|
| Rate for Payer: Midlands Choice Commercial |
$58.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.95
|
| Rate for Payer: United Healthcare Commercial |
$74.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.97
|
| Rate for Payer: Wellmark IA HMO WHPI |
$80.12
|
| Rate for Payer: Wellmark IA PPO |
$88.25
|
|
|
Bill Venipuncture
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
7845731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna of IA Commercial |
$18.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.90
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.75
|
| Rate for Payer: Medical Associates Commercial |
$15.75
|
| Rate for Payer: Midlands Choice Commercial |
$14.70
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
|
|
Bill Venipuncture
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 36415
|
| Hospital Charge Code |
7845731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$18.90 |
| Rate for Payer: Aetna of IA Commercial |
$18.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.90
|
| Rate for Payer: Aetna of IA Medicare |
$11.97
|
| Rate for Payer: Amerigroup Medicaid |
$12.11
|
| Rate for Payer: Amerigroup Medicare |
$9.54
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.00
|
| Rate for Payer: Medical Associates Commercial |
$15.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.45
|
| Rate for Payer: Midlands Choice Commercial |
$14.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.87
|
| Rate for Payer: United Healthcare Commercial |
$18.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$12.05
|
| Rate for Payer: Wellmark IA PPO |
$13.28
|
|
|
BILL WARM ABSORPTION EA
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
8015155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Aetna of IA Commercial |
$71.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$71.10
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.25
|
| Rate for Payer: Medical Associates Commercial |
$59.25
|
| Rate for Payer: Midlands Choice Commercial |
$55.30
|
| Rate for Payer: United Healthcare Commercial |
$71.10
|
|
|
BILL WARM ABSORPTION EA
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
8015155
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$35.55 |
| Max. Negotiated Rate |
$215.56 |
| Rate for Payer: Aetna of IA Commercial |
$71.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$71.10
|
| Rate for Payer: Aetna of IA Medicare |
$45.03
|
| Rate for Payer: Amerigroup Medicaid |
$45.57
|
| Rate for Payer: Amerigroup Medicare |
$35.91
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$45.12
|
| Rate for Payer: Medical Associates Commercial |
$59.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.55
|
| Rate for Payer: Midlands Choice Commercial |
$55.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$45.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$40.88
|
| Rate for Payer: United Healthcare Commercial |
$71.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$46.61
|
| Rate for Payer: Wellmark IA HMO WHPI |
$195.68
|
| Rate for Payer: Wellmark IA PPO |
$215.56
|
|
|
Bill WBC Stool Lactoferrin 89055
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
8098793
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
|
|
Bill WBC Stool Lactoferrin 89055
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 89055
|
| Hospital Charge Code |
8098793
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$18.45 |
| Max. Negotiated Rate |
$54.67 |
| Rate for Payer: Aetna of IA Commercial |
$36.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.90
|
| Rate for Payer: Aetna of IA Medicare |
$23.37
|
| Rate for Payer: Amerigroup Medicaid |
$23.65
|
| Rate for Payer: Amerigroup Medicare |
$18.63
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.42
|
| Rate for Payer: Medical Associates Commercial |
$30.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.45
|
| Rate for Payer: Midlands Choice Commercial |
$28.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.22
|
| Rate for Payer: United Healthcare Commercial |
$36.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$24.19
|
| Rate for Payer: Wellmark IA HMO WHPI |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
bimatoprost ophthalmic 0.01% Sol [VDMC]
|
Facility
|
OP
|
$939.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433412
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$422.75 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Aetna of IA Commercial |
$845.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$845.50
|
| Rate for Payer: Aetna of IA Medicare |
$535.48
|
| Rate for Payer: Amerigroup Medicaid |
$541.87
|
| Rate for Payer: Amerigroup Medicare |
$426.98
|
| Rate for Payer: Cash Price |
$751.55
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$704.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$422.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$536.61
|
| Rate for Payer: Medical Associates Commercial |
$704.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$422.75
|
| Rate for Payer: Midlands Choice Commercial |
$657.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$544.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$486.16
|
| Rate for Payer: United Healthcare Commercial |
$845.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$554.27
|
|
|
bimatoprost ophthalmic 0.01% Sol [VDMC]
|
Facility
|
IP
|
$939.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10433412
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$657.61 |
| Max. Negotiated Rate |
$845.50 |
| Rate for Payer: Aetna of IA Commercial |
$845.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$845.50
|
| Rate for Payer: Cash Price |
$751.55
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$704.58
|
| Rate for Payer: Medical Associates Commercial |
$704.58
|
| Rate for Payer: Midlands Choice Commercial |
$657.61
|
| Rate for Payer: United Healthcare Commercial |
$845.50
|
|
|
BIOCARTILAGE KIT SMALL JOINT
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8749295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.45 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna of IA Commercial |
$396.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$396.90
|
| Rate for Payer: Aetna of IA Medicare |
$251.37
|
| Rate for Payer: Amerigroup Medicaid |
$254.37
|
| Rate for Payer: Amerigroup Medicare |
$200.43
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$330.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$198.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$251.90
|
| Rate for Payer: Medical Associates Commercial |
$330.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$198.45
|
| Rate for Payer: Midlands Choice Commercial |
$308.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$255.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$228.22
|
| Rate for Payer: United Healthcare Commercial |
$396.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$260.19
|
|
|
BIOCARTILAGE KIT SMALL JOINT
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8749295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$396.90 |
| Rate for Payer: Aetna of IA Commercial |
$396.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$396.90
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$330.75
|
| Rate for Payer: Medical Associates Commercial |
$330.75
|
| Rate for Payer: Midlands Choice Commercial |
$308.70
|
| Rate for Payer: United Healthcare Commercial |
$396.90
|
|
|
BioFire 5 Point Target Panel
|
Facility
|
IP
|
$338.00
|
|
|
Service Code
|
CPT 87505
|
| Hospital Charge Code |
8906330
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
|
|
BioFire 5 Point Target Panel
|
Facility
|
OP
|
$338.00
|
|
|
Service Code
|
CPT 87505
|
| Hospital Charge Code |
8906330
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$152.10 |
| Max. Negotiated Rate |
$317.09 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Aetna of IA Medicare |
$192.66
|
| Rate for Payer: Amerigroup Medicaid |
$194.96
|
| Rate for Payer: Amerigroup Medicare |
$153.62
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$152.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$193.07
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$152.10
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$195.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$174.92
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$199.42
|
| Rate for Payer: Wellmark IA HMO WHPI |
$287.85
|
| Rate for Payer: Wellmark IA PPO |
$317.09
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC
|
Facility
|
IP
|
$18,578.62
|
|
|
Service Code
|
MSDRG 478
|
| Min. Negotiated Rate |
$18,309.36 |
| Max. Negotiated Rate |
$18,578.62 |
| Rate for Payer: Amerigroup Medicaid |
$18,488.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18,309.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,578.62
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$22,341.64
|
|
|
Service Code
|
MSDRG 477
|
| Min. Negotiated Rate |
$22,017.83 |
| Max. Negotiated Rate |
$22,341.64 |
| Rate for Payer: Amerigroup Medicaid |
$22,233.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22,017.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22,341.64
|
|
|
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
|
IP
|
$15,082.46
|
|
|
Service Code
|
MSDRG 479
|
| Min. Negotiated Rate |
$14,863.87 |
| Max. Negotiated Rate |
$15,082.46 |
| Rate for Payer: Amerigroup Medicaid |
$15,009.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14,863.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,082.46
|
|
|
BIOPSY OF BREAST OPEN
|
Facility
|
OP
|
$1,624.00
|
|
|
Service Code
|
CPT 19101
|
| Hospital Charge Code |
7983046
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$730.80 |
| Max. Negotiated Rate |
$2,997.48 |
| Rate for Payer: Aetna of IA Commercial |
$1,461.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,461.60
|
| Rate for Payer: Aetna of IA Medicare |
$925.68
|
| Rate for Payer: Amerigroup Medicaid |
$936.72
|
| Rate for Payer: Amerigroup Medicare |
$738.11
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Cash Price |
$1,299.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,218.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$730.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$927.63
|
| Rate for Payer: Medical Associates Commercial |
$1,218.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$730.80
|
| Rate for Payer: Midlands Choice Commercial |
$1,136.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$941.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$840.42
|
| Rate for Payer: United Healthcare Commercial |
$1,461.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$958.16
|
| Rate for Payer: Wellmark IA HMO WHPI |
$2,721.14
|
| Rate for Payer: Wellmark IA PPO |
$2,997.48
|
|
