|
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 |
$6.05 |
| 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 |
$7.75
|
| Rate for Payer: Amerigroup Medicare |
$6.11
|
| 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 |
$6.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.68
|
| Rate for Payer: Medical Associates Commercial |
$10.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.05
|
| Rate for Payer: Midlands Choice Commercial |
$9.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.96
|
| Rate for Payer: United Healthcare Commercial |
$12.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.93
|
|
|
imipenem-cilastatin 500 mg Inj [VDMC]
|
Facility
|
OP
|
$57.24
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
10396040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.76 |
| Max. Negotiated Rate |
$51.51 |
| Rate for Payer: Aetna of IA Commercial |
$51.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.51
|
| Rate for Payer: Aetna of IA Medicare |
$32.62
|
| Rate for Payer: Amerigroup Medicaid |
$33.01
|
| Rate for Payer: Amerigroup Medicare |
$26.01
|
| Rate for Payer: Cash Price |
$45.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.69
|
| Rate for Payer: Medical Associates Commercial |
$42.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.76
|
| Rate for Payer: Midlands Choice Commercial |
$40.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$29.62
|
| Rate for Payer: United Healthcare Commercial |
$51.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.77
|
|
|
imipenem-cilastatin 500 mg Inj [VDMC]
|
Facility
|
IP
|
$57.24
|
|
|
Service Code
|
HCPCS J0743
|
| Hospital Charge Code |
10396040
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.07 |
| Max. Negotiated Rate |
$51.51 |
| Rate for Payer: Aetna of IA Commercial |
$51.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.51
|
| Rate for Payer: Cash Price |
$45.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.93
|
| Rate for Payer: Medical Associates Commercial |
$42.93
|
| Rate for Payer: Midlands Choice Commercial |
$40.07
|
| Rate for Payer: United Healthcare Commercial |
$51.51
|
|
|
immune globulin 10% IV 100 mL SDV [VDMC]
|
Facility
|
OP
|
$2,326.12
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
10435115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,046.75 |
| Max. Negotiated Rate |
$2,093.51 |
| Rate for Payer: Aetna of IA Commercial |
$2,093.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,093.51
|
| Rate for Payer: Aetna of IA Medicare |
$1,325.89
|
| Rate for Payer: Amerigroup Medicaid |
$1,341.71
|
| Rate for Payer: Amerigroup Medicare |
$1,057.22
|
| Rate for Payer: Cash Price |
$1,860.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,744.59
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,046.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,328.68
|
| Rate for Payer: Medical Associates Commercial |
$1,744.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,046.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,628.28
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,348.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,203.77
|
| Rate for Payer: United Healthcare Commercial |
$2,093.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,372.41
|
|
|
immune globulin 10% IV 100 mL SDV [VDMC]
|
Facility
|
IP
|
$2,326.12
|
|
|
Service Code
|
HCPCS J1459
|
| Hospital Charge Code |
10435115
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,628.28 |
| Max. Negotiated Rate |
$2,093.51 |
| Rate for Payer: Aetna of IA Commercial |
$2,093.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,093.51
|
| Rate for Payer: Cash Price |
$1,860.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,744.59
|
| Rate for Payer: Medical Associates Commercial |
$1,744.59
|
| Rate for Payer: Midlands Choice Commercial |
$1,628.28
|
| Rate for Payer: United Healthcare Commercial |
$2,093.51
|
|
|
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 |
$1,900.92 |
| Max. Negotiated Rate |
$3,801.84 |
| Rate for Payer: Aetna of IA Commercial |
$3,801.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,801.84
|
| Rate for Payer: Aetna of IA Medicare |
$2,407.83
|
| Rate for Payer: Amerigroup Medicaid |
$2,436.55
|
| Rate for Payer: Amerigroup Medicare |
$1,919.93
|
| 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 |
$1,900.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,412.90
|
| Rate for Payer: Medical Associates Commercial |
$3,168.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,900.92
|
| Rate for Payer: Midlands Choice Commercial |
$2,956.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,448.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,186.06
|
| Rate for Payer: United Healthcare Commercial |
$3,801.84
|
| 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 |
$3,801.84 |
| Rate for Payer: Aetna of IA Commercial |
$3,801.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,801.84
|
| 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 |
$3,801.84
|
|
|
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 |
$354.32 |
| 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 |
$454.16
|
| Rate for Payer: Amerigroup Medicare |
$357.86
|
| 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 |
$354.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$449.75
|
| Rate for Payer: Medical Associates Commercial |
$590.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$354.32
|
| Rate for Payer: Midlands Choice Commercial |
$551.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$456.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$407.47
|
| Rate for Payer: United Healthcare Commercial |
$708.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$464.55
|
|
|
Immunofixation Serum DMCL
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
8037877
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$104.98
|
| Rate for Payer: Amerigroup Medicare |
$82.72
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$136.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.96
|
| Rate for Payer: Medical Associates Commercial |
$136.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.90
|
| Rate for Payer: Midlands Choice Commercial |
$127.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$105.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$94.18
|
| Rate for Payer: United Healthcare Commercial |
$163.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$107.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
8037717
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$104.98
|
| Rate for Payer: Amerigroup Medicare |
$82.72
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$136.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.96
|
| Rate for Payer: Medical Associates Commercial |
$136.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.90
|
| Rate for Payer: Midlands Choice Commercial |
$127.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$105.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$94.18
|
| Rate for Payer: United Healthcare Commercial |
$163.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$107.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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
|
|
|
Immunoglobulin E DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
8037718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| 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: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Immunoglobulin E DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
8037718
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| 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 |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| 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 |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
IMMUNOGLOBULIN FREE LT CHAIN
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
8093938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Aetna of IA Medicare |
$74.10
|
| Rate for Payer: Amerigroup Medicaid |
$74.98
|
| Rate for Payer: Amerigroup Medicare |
$59.08
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.26
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$67.28
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
IMMUNOGLOBULIN FREE LT CHAIN
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
8093938
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
|
|
IMMUNOGLOBULIN IGA, IGD, IGG, IGM EACH
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
8093939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.49 |
| 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 |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| 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 |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
IMMUNOGLOBULIN IGA, IGD, IGG, IGM EACH
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
8093939
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| 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: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
Immunoglobulin Panel IgG IgA IgM DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
8037719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.49 |
| 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 |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| 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 |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
Immunoglobulin Panel IgG IgA IgM DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
8037719
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| 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: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
IMPLANT ANCHOR-JUGGERKNOT 1.4MM SHORT
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.50 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna of IA Commercial |
$607.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$607.50
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$506.25
|
| Rate for Payer: Medical Associates Commercial |
$506.25
|
| Rate for Payer: Midlands Choice Commercial |
$472.50
|
| Rate for Payer: United Healthcare Commercial |
$607.50
|
|
|
IMPLANT ANCHOR-JUGGERKNOT 1.4MM SHORT
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047021
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$303.75 |
| Max. Negotiated Rate |
$607.50 |
| Rate for Payer: Aetna of IA Commercial |
$607.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$607.50
|
| Rate for Payer: Aetna of IA Medicare |
$384.75
|
| Rate for Payer: Amerigroup Medicaid |
$389.34
|
| Rate for Payer: Amerigroup Medicare |
$306.79
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$506.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$303.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$385.56
|
| Rate for Payer: Medical Associates Commercial |
$506.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$303.75
|
| Rate for Payer: Midlands Choice Commercial |
$472.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$391.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$349.31
|
| Rate for Payer: United Healthcare Commercial |
$607.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$398.25
|
|
|
IMPLANT BIPOLAR COMP UNIV HEAD 26MMX41MM
|
Facility
|
IP
|
$2,487.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8026548
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,740.90 |
| Max. Negotiated Rate |
$2,238.30 |
| Rate for Payer: Aetna of IA Commercial |
$2,238.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,238.30
|
| Rate for Payer: Cash Price |
$1,989.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,865.25
|
| Rate for Payer: Medical Associates Commercial |
$1,865.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,740.90
|
| Rate for Payer: United Healthcare Commercial |
$2,238.30
|
|
