|
propylthiouracil 50 mg Tab [VDMC]
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417350
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$2.69 |
| Rate for Payer: Aetna of IA Commercial |
$2.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.69
|
| Rate for Payer: Aetna of IA Medicare |
$1.70
|
| Rate for Payer: Amerigroup Medicaid |
$1.72
|
| Rate for Payer: Amerigroup Medicare |
$1.36
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.71
|
| Rate for Payer: Medical Associates Commercial |
$2.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$2.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$2.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.76
|
|
|
PROSTH TRAIN 15 MIN EACH
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
1042081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
PROSTH TRAIN 15 MIN EACH
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 97761 GP
|
| Hospital Charge Code |
1042081
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$59.99
|
| Rate for Payer: Amerigroup Medicare |
$47.27
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$46.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.40
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.80
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.82
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
|
PROS TR 15 MIN
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 97761 GO
|
| Hospital Charge Code |
1373575
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
PROS TR 15 MIN
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 97761 GO
|
| Hospital Charge Code |
1373575
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$59.99
|
| Rate for Payer: Amerigroup Medicare |
$47.27
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$46.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.40
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.80
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.82
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
|
Protamine Sulfate 10 mg/mL 25ml SDV [VDMC]
|
Facility
|
OP
|
$139.24
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
19647995
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.66 |
| Max. Negotiated Rate |
$125.32 |
| Rate for Payer: Aetna of IA Commercial |
$125.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.32
|
| Rate for Payer: Aetna of IA Medicare |
$79.37
|
| Rate for Payer: Amerigroup Medicaid |
$80.31
|
| Rate for Payer: Amerigroup Medicare |
$63.28
|
| Rate for Payer: Cash Price |
$111.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.43
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.53
|
| Rate for Payer: Medical Associates Commercial |
$104.43
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.66
|
| Rate for Payer: Midlands Choice Commercial |
$97.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$72.06
|
| Rate for Payer: United Healthcare Commercial |
$125.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.15
|
|
|
Protamine Sulfate 10 mg/mL 25ml SDV [VDMC]
|
Facility
|
IP
|
$139.24
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
19647995
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$97.47 |
| Max. Negotiated Rate |
$125.32 |
| Rate for Payer: Aetna of IA Commercial |
$125.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.32
|
| Rate for Payer: Cash Price |
$111.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.43
|
| Rate for Payer: Medical Associates Commercial |
$104.43
|
| Rate for Payer: Midlands Choice Commercial |
$97.47
|
| Rate for Payer: United Healthcare Commercial |
$125.32
|
|
|
Protamine Sulfate 10 mg/mL 5 ml SDV [VDMC]
|
Facility
|
IP
|
$59.70
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
10417419
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Aetna of IA Commercial |
$53.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.73
|
| Rate for Payer: Cash Price |
$47.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.77
|
| Rate for Payer: Medical Associates Commercial |
$44.77
|
| Rate for Payer: Midlands Choice Commercial |
$41.79
|
| Rate for Payer: United Healthcare Commercial |
$53.73
|
|
|
Protamine Sulfate 10 mg/mL 5 ml SDV [VDMC]
|
Facility
|
OP
|
$59.70
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
10417419
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.86 |
| Max. Negotiated Rate |
$53.73 |
| Rate for Payer: Aetna of IA Commercial |
$53.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.73
|
| Rate for Payer: Aetna of IA Medicare |
$34.03
|
| Rate for Payer: Amerigroup Medicaid |
$34.43
|
| Rate for Payer: Amerigroup Medicare |
$27.13
|
| Rate for Payer: Cash Price |
$47.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.77
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.10
|
| Rate for Payer: Medical Associates Commercial |
$44.77
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.86
|
| Rate for Payer: Midlands Choice Commercial |
$41.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.89
|
| Rate for Payer: United Healthcare Commercial |
$53.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.22
|
|
|
Protein C Activity DMCL
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
8037785
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$86.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna of IA Commercial |
$111.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.00
|
| Rate for Payer: Medical Associates Commercial |
$93.00
|
| Rate for Payer: Midlands Choice Commercial |
$86.80
|
| Rate for Payer: United Healthcare Commercial |
$111.60
|
|
|
Protein C Activity DMCL
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
8037785
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$55.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Aetna of IA Commercial |
$111.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.60
|
| Rate for Payer: Aetna of IA Medicare |
$70.68
|
| Rate for Payer: Amerigroup Medicaid |
$71.52
|
| Rate for Payer: Amerigroup Medicare |
$56.36
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.83
|
| Rate for Payer: Medical Associates Commercial |
$93.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.80
|
| Rate for Payer: Midlands Choice Commercial |
$86.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.17
|
| Rate for Payer: United Healthcare Commercial |
$111.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.16
|
|
|
Protein C Antigen DMCL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
8037786
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
|
|
Protein C Antigen DMCL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
8037786
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Aetna of IA Medicare |
$55.86
|
| Rate for Payer: Amerigroup Medicaid |
$56.53
|
| Rate for Payer: Amerigroup Medicare |
$44.54
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.98
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.10
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.72
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$57.82
|
|
|
Protein Electrophoresis DMCL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
8037787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$59.99
|
| Rate for Payer: Amerigroup Medicare |
$47.27
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$46.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.40
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.80
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.82
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
|
Protein Electrophoresis DMCL
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
8037787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
PROTEIN S ACTIVITY
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
8093943
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
|
PROTEIN S ACTIVITY
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
8093943
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$65.70 |
| 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: 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
|
|
|
Protein S Activity DMCL
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
8037788
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
|
Protein S Activity DMCL
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
8037788
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$65.70 |
| 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: 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
|
|
|
Protein S Free Antigen with Reflex DMCL
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
8037789
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$65.70 |
| 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: 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
|
|
|
Protein S Free Antigen with Reflex DMCL
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
8037789
|
|
Hospital Revenue Code
|
305
|
| 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
|
|
|
Protein Total DMCL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
8037790
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$23.07
|
| Rate for Payer: Amerigroup Medicare |
$18.18
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.85
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.70
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
|
|
Protein Total DMCL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
8037790
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
Protein Urine Random DMCL
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
8037738
|
|
Hospital Revenue Code
|
301
|
| 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: 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
|
|
|
Protein Urine Random DMCL
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
8037738
|
|
Hospital Revenue Code
|
301
|
| 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
|
|
