|
ID Only
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
8089012
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Aetna of IA Medicare |
$33.63
|
| Rate for Payer: Amerigroup Medicaid |
$29.78
|
| Rate for Payer: Amerigroup Medicare |
$29.80
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.49
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.50
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.94
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$29.92
|
| Rate for Payer: Oscar Health of IA Commercial |
$44.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.25
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.81
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
ID PILONIDAL CYST ER CHARGE
|
Professional
|
Both
|
$570.00
|
|
| Hospital Charge Code |
8069110
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Medical Associates Commercial |
$427.50
|
| Rate for Payer: Midlands Choice Commercial |
$399.00
|
|
|
imatinib 400 mg Tab [VDMC]
|
Facility
|
IP
|
$13.44
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
22151261
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna of IA Commercial |
$12.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.10
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.08
|
| Rate for Payer: Medical Associates Commercial |
$10.08
|
| Rate for Payer: Midlands Choice Commercial |
$9.41
|
| Rate for Payer: United Healthcare Commercial |
$12.10
|
|
|
imatinib 400 mg Tab [VDMC]
|
Facility
|
OP
|
$13.44
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
22151261
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$12.10 |
| Rate for Payer: Aetna of IA Commercial |
$12.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.10
|
| Rate for Payer: Aetna of IA Medicare |
$7.66
|
| Rate for Payer: Amerigroup Medicaid |
$6.78
|
| Rate for Payer: Amerigroup Medicare |
$6.79
|
| Rate for Payer: Cash Price |
$10.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.72
|
| Rate for Payer: Medical Associates Commercial |
$10.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.72
|
| Rate for Payer: Midlands Choice Commercial |
$9.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$6.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$10.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.08
|
| Rate for Payer: United Healthcare Commercial |
$12.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.93
|
|
|
imipenem-cilastatin 500 mg Inj [VDMC]
|
Facility
|
IP
|
$59.09
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
10396040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$53.18 |
| Rate for Payer: Aetna of IA Commercial |
$53.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.18
|
| Rate for Payer: Cash Price |
$47.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.32
|
| Rate for Payer: Medical Associates Commercial |
$44.32
|
| Rate for Payer: Midlands Choice Commercial |
$41.36
|
| Rate for Payer: United Healthcare Commercial |
$53.18
|
|
|
imipenem-cilastatin 500 mg Inj [VDMC]
|
Facility
|
OP
|
$59.09
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
10396040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.53 |
| Max. Negotiated Rate |
$53.18 |
| Rate for Payer: Aetna of IA Commercial |
$53.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.18
|
| Rate for Payer: Aetna of IA Medicare |
$33.68
|
| Rate for Payer: Amerigroup Medicaid |
$29.82
|
| Rate for Payer: Amerigroup Medicare |
$29.84
|
| Rate for Payer: Cash Price |
$47.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.53
|
| Rate for Payer: Medical Associates Commercial |
$44.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.54
|
| Rate for Payer: Midlands Choice Commercial |
$41.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.99
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$29.97
|
| Rate for Payer: Oscar Health of IA Commercial |
$44.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.32
|
| Rate for Payer: United Healthcare Commercial |
$53.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.86
|
|
|
immune globulin 10% IV 100 mL SDV [VDMC]
|
Facility
|
OP
|
$2,180.08
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
10435115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,089.60 |
| Max. Negotiated Rate |
$1,962.07 |
| Rate for Payer: Aetna of IA Commercial |
$1,962.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,962.07
|
| Rate for Payer: Aetna of IA Medicare |
$1,242.65
|
| Rate for Payer: Amerigroup Medicaid |
$1,100.29
|
| Rate for Payer: Amerigroup Medicare |
$1,100.94
|
| Rate for Payer: Cash Price |
$1,744.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,635.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,090.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,089.60
|
| Rate for Payer: Medical Associates Commercial |
$1,635.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,090.04
|
| Rate for Payer: Midlands Choice Commercial |
$1,526.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,106.39
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,105.74
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,635.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,635.06
|
| Rate for Payer: United Healthcare Commercial |
$1,962.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,286.25
|
|
|
immune globulin 10% IV 100 mL SDV [VDMC]
|
Facility
|
IP
|
$2,180.08
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
10435115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,526.06 |
| Max. Negotiated Rate |
$1,962.07 |
| Rate for Payer: Aetna of IA Commercial |
$1,962.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,962.07
|
| Rate for Payer: Cash Price |
$1,744.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,635.06
|
| Rate for Payer: Medical Associates Commercial |
$1,635.06
|
| Rate for Payer: Midlands Choice Commercial |
$1,526.06
|
| Rate for Payer: United Healthcare Commercial |
$1,962.07
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 100 mL [VDMC]
|
Facility
|
OP
|
$1,732.98
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
11860490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$866.14 |
| Max. Negotiated Rate |
$1,559.68 |
| Rate for Payer: Aetna of IA Commercial |
$1,559.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,559.68
|
| Rate for Payer: Aetna of IA Medicare |
$987.80
|
| Rate for Payer: Amerigroup Medicaid |
$874.64
|
| Rate for Payer: Amerigroup Medicare |
$875.15
|
| Rate for Payer: Cash Price |
$1,386.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,299.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$866.49
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$866.14
|
| Rate for Payer: Medical Associates Commercial |
$1,299.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$866.49
|
| Rate for Payer: Midlands Choice Commercial |
$1,213.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$879.49
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$878.97
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,299.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,299.74
|
| Rate for Payer: United Healthcare Commercial |
$1,559.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,022.46
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 100 mL [VDMC]
|
Facility
|
IP
|
$1,732.98
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
11860490
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,213.09 |
| Max. Negotiated Rate |
$1,559.68 |
| Rate for Payer: Aetna of IA Commercial |
$1,559.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,559.68
|
| Rate for Payer: Cash Price |
$1,386.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,299.74
|
| Rate for Payer: Medical Associates Commercial |
$1,299.74
|
| Rate for Payer: Midlands Choice Commercial |
$1,213.09
|
| Rate for Payer: United Healthcare Commercial |
$1,559.68
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 10 mL [VDMC]
|
Facility
|
IP
|
$332.32
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
11860604
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$232.62 |
| Max. Negotiated Rate |
$299.09 |
| Rate for Payer: Aetna of IA Commercial |
$299.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.09
|
| Rate for Payer: Cash Price |
$265.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.24
|
| Rate for Payer: Medical Associates Commercial |
$249.24
|
| Rate for Payer: Midlands Choice Commercial |
$232.62
|
| Rate for Payer: United Healthcare Commercial |
$299.09
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 10 mL [VDMC]
|
Facility
|
OP
|
$332.32
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
11860604
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$166.09 |
| Max. Negotiated Rate |
$299.09 |
| Rate for Payer: Aetna of IA Commercial |
$299.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$299.09
|
| Rate for Payer: Aetna of IA Medicare |
$189.42
|
| Rate for Payer: Amerigroup Medicaid |
$167.72
|
| Rate for Payer: Amerigroup Medicare |
$167.82
|
| Rate for Payer: Cash Price |
$265.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$249.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$166.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.09
|
| Rate for Payer: Medical Associates Commercial |
$249.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$166.16
|
| Rate for Payer: Midlands Choice Commercial |
$232.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$168.65
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$168.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$249.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$249.24
|
| Rate for Payer: United Healthcare Commercial |
$299.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$196.07
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 200 mL [VDMC]
|
Facility
|
OP
|
$3,365.96
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
11860701
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,682.31 |
| Max. Negotiated Rate |
$3,029.36 |
| Rate for Payer: Aetna of IA Commercial |
$3,029.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,029.36
|
| Rate for Payer: Aetna of IA Medicare |
$1,918.60
|
| Rate for Payer: Amerigroup Medicaid |
$1,698.80
|
| Rate for Payer: Amerigroup Medicare |
$1,699.81
|
| Rate for Payer: Cash Price |
$2,692.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,524.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,682.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,682.31
|
| Rate for Payer: Medical Associates Commercial |
$2,524.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,682.98
|
| Rate for Payer: Midlands Choice Commercial |
$2,356.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,708.22
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,707.21
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,524.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,524.47
|
| Rate for Payer: United Healthcare Commercial |
$3,029.36
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,985.92
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 200 mL [VDMC]
|
Facility
|
IP
|
$3,365.96
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
11860701
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2,356.17 |
| Max. Negotiated Rate |
$3,029.36 |
| Rate for Payer: Aetna of IA Commercial |
$3,029.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,029.36
|
| Rate for Payer: Cash Price |
$2,692.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,524.47
|
| Rate for Payer: Medical Associates Commercial |
$2,524.47
|
| Rate for Payer: Midlands Choice Commercial |
$2,356.17
|
| Rate for Payer: United Healthcare Commercial |
$3,029.36
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 300 ML GG [VDMC]
|
Facility
|
OP
|
$4,224.26
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
25218377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2,111.29 |
| Max. Negotiated Rate |
$3,801.83 |
| Rate for Payer: Aetna of IA Commercial |
$3,801.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,801.83
|
| Rate for Payer: Aetna of IA Medicare |
$2,407.83
|
| Rate for Payer: Amerigroup Medicaid |
$2,131.98
|
| Rate for Payer: Amerigroup Medicare |
$2,133.25
|
| Rate for Payer: Cash Price |
$3,379.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,168.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,112.13
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,111.29
|
| Rate for Payer: Medical Associates Commercial |
$3,168.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,112.13
|
| Rate for Payer: Midlands Choice Commercial |
$2,956.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,143.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2,142.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,168.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,168.20
|
| Rate for Payer: United Healthcare Commercial |
$3,801.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,492.31
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 300 ML GG [VDMC]
|
Facility
|
IP
|
$4,224.26
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
25218377
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2,956.98 |
| Max. Negotiated Rate |
$3,801.83 |
| Rate for Payer: Aetna of IA Commercial |
$3,801.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,801.83
|
| Rate for Payer: Cash Price |
$3,379.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,168.20
|
| Rate for Payer: Medical Associates Commercial |
$3,168.20
|
| Rate for Payer: Midlands Choice Commercial |
$2,956.98
|
| Rate for Payer: United Healthcare Commercial |
$3,801.83
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 50 ML GG [VDMC]
|
Facility
|
IP
|
$787.38
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
25217270
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$551.17 |
| Max. Negotiated Rate |
$708.64 |
| Rate for Payer: Aetna of IA Commercial |
$708.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$708.64
|
| Rate for Payer: Cash Price |
$629.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$590.54
|
| Rate for Payer: Medical Associates Commercial |
$590.54
|
| Rate for Payer: Midlands Choice Commercial |
$551.17
|
| Rate for Payer: United Healthcare Commercial |
$708.64
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 50 ML GG [VDMC]
|
Facility
|
OP
|
$787.38
|
|
|
Service Code
|
HCPCS J1569
|
| Hospital Charge Code |
25217270
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$393.53 |
| Max. Negotiated Rate |
$708.64 |
| Rate for Payer: Aetna of IA Commercial |
$708.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$708.64
|
| Rate for Payer: Aetna of IA Medicare |
$448.81
|
| Rate for Payer: Amerigroup Medicaid |
$397.39
|
| Rate for Payer: Amerigroup Medicare |
$397.63
|
| Rate for Payer: Cash Price |
$629.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$590.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$393.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$393.53
|
| Rate for Payer: Medical Associates Commercial |
$590.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$393.69
|
| Rate for Payer: Midlands Choice Commercial |
$551.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$399.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$399.36
|
| Rate for Payer: Oscar Health of IA Commercial |
$590.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$590.54
|
| Rate for Payer: United Healthcare Commercial |
$708.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$464.55
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 50 ML[VDMC]
|
Facility
|
IP
|
$916.48
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
12214429
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$641.54 |
| Max. Negotiated Rate |
$824.83 |
| Rate for Payer: Aetna of IA Commercial |
$824.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$824.83
|
| Rate for Payer: Cash Price |
$733.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$687.36
|
| Rate for Payer: Medical Associates Commercial |
$687.36
|
| Rate for Payer: Midlands Choice Commercial |
$641.54
|
| Rate for Payer: United Healthcare Commercial |
$824.83
|
|
|
immune globulin intravenous and subcutaneous 10% Sol 50 ML[VDMC]
|
Facility
|
OP
|
$916.48
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
12214429
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$458.06 |
| Max. Negotiated Rate |
$824.83 |
| Rate for Payer: Aetna of IA Commercial |
$824.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$824.83
|
| Rate for Payer: Aetna of IA Medicare |
$522.39
|
| Rate for Payer: Amerigroup Medicaid |
$462.55
|
| Rate for Payer: Amerigroup Medicare |
$462.82
|
| Rate for Payer: Cash Price |
$733.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$687.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$458.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$458.06
|
| Rate for Payer: Medical Associates Commercial |
$687.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$458.24
|
| Rate for Payer: Midlands Choice Commercial |
$641.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$465.11
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$464.84
|
| Rate for Payer: Oscar Health of IA Commercial |
$687.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$687.36
|
| Rate for Payer: United Healthcare Commercial |
$824.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$540.72
|
|
|
Immunofixation Serum DMCL
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
8037877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| 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: Aetna of IA Medicare |
$103.74
|
| Rate for Payer: Amerigroup Medicaid |
$91.86
|
| Rate for Payer: Amerigroup Medicare |
$91.91
|
| 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 |
$91.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.96
|
| Rate for Payer: Medical Associates Commercial |
$136.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$91.00
|
| Rate for Payer: Midlands Choice Commercial |
$127.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.36
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$92.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$136.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$136.50
|
| Rate for Payer: United Healthcare Commercial |
$163.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$107.38
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Immunofixation Serum DMCL
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
8037877
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
Immunofixation Urine DMCL
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
8037717
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
Immunofixation Urine DMCL
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
8037717
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| 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: Aetna of IA Medicare |
$103.74
|
| Rate for Payer: Amerigroup Medicaid |
$91.86
|
| Rate for Payer: Amerigroup Medicare |
$91.91
|
| 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 |
$91.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$90.96
|
| Rate for Payer: Medical Associates Commercial |
$136.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$91.00
|
| Rate for Payer: Midlands Choice Commercial |
$127.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.36
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$92.31
|
| Rate for Payer: Oscar Health of IA Commercial |
$136.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$136.50
|
| Rate for Payer: United Healthcare Commercial |
$163.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$107.38
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Immunoglobulin E DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
8037718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
