|
BLOOD TRANSFUSION, SCHEDULED
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 36430
|
| Hospital Charge Code |
8012930
|
|
Hospital Revenue Code
|
391
|
| Min. Negotiated Rate |
$307.80 |
| Max. Negotiated Rate |
$615.60 |
| Rate for Payer: Aetna of IA Commercial |
$615.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$615.60
|
| Rate for Payer: Aetna of IA Medicare |
$389.88
|
| Rate for Payer: Amerigroup Medicaid |
$394.53
|
| Rate for Payer: Amerigroup Medicare |
$310.88
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$513.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$307.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$390.70
|
| Rate for Payer: Medical Associates Commercial |
$513.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$307.80
|
| Rate for Payer: Midlands Choice Commercial |
$478.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$396.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$353.97
|
| Rate for Payer: United Healthcare Commercial |
$615.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$403.56
|
| Rate for Payer: Wellmark IA HMO WHPI |
$431.78
|
| Rate for Payer: Wellmark IA PPO |
$475.63
|
|
|
BLOOD TYPE ABO/RH TYPING
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
634326
|
|
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
|
|
|
BLOOD TYPE ABO/RH TYPING
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
634326
|
|
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
|
|
|
BLS EMERGENCY
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
HCPCS A0429 QN
|
| Hospital Charge Code |
5230785
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$418.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Aetna of IA Commercial |
$538.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$538.20
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$448.50
|
| Rate for Payer: Medical Associates Commercial |
$448.50
|
| Rate for Payer: Midlands Choice Commercial |
$418.60
|
| Rate for Payer: United Healthcare Commercial |
$538.20
|
|
|
BLS EMERGENCY
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
HCPCS A0429 QN
|
| Hospital Charge Code |
5230785
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$269.10 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Aetna of IA Commercial |
$538.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$538.20
|
| Rate for Payer: Aetna of IA Medicare |
$340.86
|
| Rate for Payer: Amerigroup Medicaid |
$344.93
|
| Rate for Payer: Amerigroup Medicare |
$271.79
|
| Rate for Payer: Cash Price |
$478.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$448.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$269.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$341.58
|
| Rate for Payer: Medical Associates Commercial |
$448.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$269.10
|
| Rate for Payer: Midlands Choice Commercial |
$418.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$346.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$309.46
|
| Rate for Payer: United Healthcare Commercial |
$538.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$508.30
|
|
|
BLS NON EMERGENCY
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
HCPCS A0428
|
| Hospital Charge Code |
8059609
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$200.70 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Aetna of IA Commercial |
$401.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$401.40
|
| Rate for Payer: Aetna of IA Medicare |
$254.22
|
| Rate for Payer: Amerigroup Medicaid |
$257.25
|
| Rate for Payer: Amerigroup Medicare |
$202.71
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$334.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$200.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$254.76
|
| Rate for Payer: Medical Associates Commercial |
$334.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$200.70
|
| Rate for Payer: Midlands Choice Commercial |
$312.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$258.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$230.80
|
| Rate for Payer: United Healthcare Commercial |
$401.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$379.10
|
|
|
BLS NON EMERGENCY
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
HCPCS A0428
|
| Hospital Charge Code |
8059609
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$312.20 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Aetna of IA Commercial |
$401.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$401.40
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$334.50
|
| Rate for Payer: Medical Associates Commercial |
$334.50
|
| Rate for Payer: Midlands Choice Commercial |
$312.20
|
| Rate for Payer: United Healthcare Commercial |
$401.40
|
|
|
B NATURIURETIC PEPTIDE
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
1383771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of IA Commercial |
$207.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.90
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$173.25
|
| Rate for Payer: Medical Associates Commercial |
$173.25
|
| Rate for Payer: Midlands Choice Commercial |
$161.70
|
| Rate for Payer: United Healthcare Commercial |
$207.90
|
|
|
B NATURIURETIC PEPTIDE
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
1383771
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$103.95 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna of IA Commercial |
$207.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.90
|
| Rate for Payer: Aetna of IA Medicare |
$131.67
|
| Rate for Payer: Amerigroup Medicaid |
$133.24
|
| Rate for Payer: Amerigroup Medicare |
$104.99
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$173.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$103.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$131.95
|
| Rate for Payer: Medical Associates Commercial |
$173.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.95
|
| Rate for Payer: Midlands Choice Commercial |
$161.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$133.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$119.54
|
| Rate for Payer: United Healthcare Commercial |
$207.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$136.29
|
| Rate for Payer: Wellmark IA HMO WHPI |
$121.95
|
| Rate for Payer: Wellmark IA PPO |
$134.33
|
|
|
BODY FLUID ALBUMIN
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
7934761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Aetna of IA Medicare |
$83.22
|
| Rate for Payer: Amerigroup Medicaid |
$84.21
|
| Rate for Payer: Amerigroup Medicare |
$66.36
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$65.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$83.40
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.70
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$84.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.56
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.14
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
BODY FLUID ALBUMIN
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
8093928
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
|
|
BODY FLUID ALBUMIN
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
8093928
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.49 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Aetna of IA Medicare |
$83.22
|
| Rate for Payer: Amerigroup Medicaid |
$84.21
|
| Rate for Payer: Amerigroup Medicare |
$66.36
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$65.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$83.40
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.70
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$84.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.56
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.14
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
BODY FLUID ALBUMIN
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
7934761
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$102.20 |
| Max. Negotiated Rate |
$131.40 |
| Rate for Payer: Aetna of IA Commercial |
$131.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.40
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.50
|
| Rate for Payer: Medical Associates Commercial |
$109.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.20
|
| Rate for Payer: United Healthcare Commercial |
$131.40
|
|
|
BODY FLUID CELL COUNT
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
4006786
|
|
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
|
|
|
BODY FLUID CELL COUNT
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
4006785
|
|
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
|
|
|
BODY FLUID CELL COUNT
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
4006786
|
|
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
|
|
|
BODY FLUID CELL COUNT
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
4006785
|
|
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
|
|
|
BODY FLUID CRYSTALS
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
4022819
|
|
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
|
|
|
BODY FLUID CRYSTALS
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
4022819
|
|
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
|
|
|
BODY FLUID GLUCOSE
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
4022832
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
BODY FLUID GLUCOSE
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
1628897
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$35.18
|
| Rate for Payer: Amerigroup Medicare |
$27.72
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.84
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.45
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.57
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
BODY FLUID GLUCOSE
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
1628897
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
BODY FLUID GLUCOSE
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
4022832
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$35.18
|
| Rate for Payer: Amerigroup Medicare |
$27.72
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.84
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.45
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.57
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
BODY FLUID PROTEIN
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
1634881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$35.18
|
| Rate for Payer: Amerigroup Medicare |
$27.72
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.84
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.45
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.57
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
BODY FLUID PROTEIN
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
1634881
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
