|
propranolol 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of IA Commercial |
$1.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.42
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.18
|
| Rate for Payer: Medical Associates Commercial |
$1.18
|
| Rate for Payer: Midlands Choice Commercial |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
|
|
propranolol 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417141
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of IA Commercial |
$1.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.42
|
| Rate for Payer: Aetna of IA Medicare |
$0.90
|
| Rate for Payer: Amerigroup Medicaid |
$0.80
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.79
|
| Rate for Payer: Medical Associates Commercial |
$1.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.79
|
| Rate for Payer: Midlands Choice Commercial |
$1.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.80
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.18
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.93
|
|
|
propranolol 60 mg ER Cap [VDMC]
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Aetna of IA Medicare |
$1.02
|
| Rate for Payer: Amerigroup Medicaid |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.90
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.91
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.91
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.06
|
|
|
propranolol 60 mg ER Cap [VDMC]
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417210
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
|
|
propranolol 80 mg ERCap [VDMC]
|
Facility
|
OP
|
$1.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417281
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna of IA Commercial |
$1.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.69
|
| Rate for Payer: Aetna of IA Medicare |
$1.07
|
| Rate for Payer: Amerigroup Medicaid |
$0.95
|
| Rate for Payer: Amerigroup Medicare |
$0.95
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.94
|
| Rate for Payer: Medical Associates Commercial |
$1.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.94
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.95
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.95
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.41
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.11
|
|
|
propranolol 80 mg ERCap [VDMC]
|
Facility
|
IP
|
$1.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417281
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Aetna of IA Commercial |
$1.69
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.69
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.41
|
| Rate for Payer: Medical Associates Commercial |
$1.41
|
| Rate for Payer: Midlands Choice Commercial |
$1.32
|
| Rate for Payer: United Healthcare Commercial |
$1.69
|
|
|
propylthiouracil 50 mg Tab [VDMC]
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417350
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.49 |
| 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 |
$1.51
|
| Rate for Payer: Amerigroup Medicare |
$1.51
|
| 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 |
$1.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.49
|
| Rate for Payer: Medical Associates Commercial |
$2.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.50
|
| Rate for Payer: Midlands Choice Commercial |
$2.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.52
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.52
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.24
|
| Rate for Payer: United Healthcare Commercial |
$2.69
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.76
|
|
|
propylthiouracil 50 mg Tab [VDMC]
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10417350
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.09 |
| 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: Cash Price |
$2.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.24
|
| Rate for Payer: Medical Associates Commercial |
$2.24
|
| Rate for Payer: Midlands Choice Commercial |
$2.09
|
| Rate for Payer: United Healthcare Commercial |
$2.69
|
|
|
Prostatectomy With CC
|
Facility
|
IP
|
$12,453.61
|
|
|
Service Code
|
MS-DRG 666
|
| Hospital Charge Code |
448
|
| Min. Negotiated Rate |
$12,273.12 |
| Max. Negotiated Rate |
$12,453.61 |
| Rate for Payer: Amerigroup Medicaid |
$12,393.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,273.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,453.61
|
|
|
Prostatectomy With MCC
|
Facility
|
IP
|
$29,896.34
|
|
|
Service Code
|
MS-DRG 665
|
| Hospital Charge Code |
447
|
| Min. Negotiated Rate |
$29,463.06 |
| Max. Negotiated Rate |
$29,896.34 |
| Rate for Payer: Amerigroup Medicaid |
$29,751.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29,463.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29,896.34
|
|
|
Prostatectomy Without CC/MCC
|
Facility
|
IP
|
$7,755.82
|
|
|
Service Code
|
MS-DRG 667
|
| Hospital Charge Code |
449
|
| Min. Negotiated Rate |
$7,643.42 |
| Max. Negotiated Rate |
$7,755.82 |
| Rate for Payer: Amerigroup Medicaid |
$7,718.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,643.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,755.82
|
|
|
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 |
$51.98 |
| 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 |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| 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 |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$52.75
|
| Rate for Payer: Oscar Health of IA Commercial |
$78.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
|
|
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: Medical Associates Commercial |
$78.00
|
| 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: 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 |
$51.98 |
| 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 |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| 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 |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$52.75
|
| Rate for Payer: Oscar Health of IA Commercial |
$78.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| 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
|
|
|
Protamine Sulfate 10 mg/mL 25ml SDV [VDMC]
|
Facility
|
IP
|
$124.16
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
19647995
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$86.91 |
| Max. Negotiated Rate |
$111.74 |
| Rate for Payer: Aetna of IA Commercial |
$111.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.74
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.12
|
| Rate for Payer: Medical Associates Commercial |
$93.12
|
| Rate for Payer: Midlands Choice Commercial |
$86.91
|
| Rate for Payer: United Healthcare Commercial |
$111.74
|
|
|
Protamine Sulfate 10 mg/mL 25ml SDV [VDMC]
|
Facility
|
OP
|
$124.16
|
|
|
Service Code
|
HCPCS J2720
|
| Hospital Charge Code |
19647995
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$62.06 |
| Max. Negotiated Rate |
$111.74 |
| Rate for Payer: Aetna of IA Commercial |
$111.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$111.74
|
| Rate for Payer: Aetna of IA Medicare |
$70.77
|
| Rate for Payer: Amerigroup Medicaid |
$62.66
|
| Rate for Payer: Amerigroup Medicare |
$62.70
|
| Rate for Payer: Cash Price |
$99.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.06
|
| Rate for Payer: Medical Associates Commercial |
$93.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.08
|
| Rate for Payer: Midlands Choice Commercial |
$86.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.01
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$62.97
|
| Rate for Payer: Oscar Health of IA Commercial |
$93.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.12
|
| Rate for Payer: United Healthcare Commercial |
$111.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.25
|
|
|
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 |
$44.78
|
| Rate for Payer: Medical Associates Commercial |
$44.78
|
| 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 |
$29.84 |
| 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 |
$30.13
|
| Rate for Payer: Amerigroup Medicare |
$30.15
|
| Rate for Payer: Cash Price |
$47.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.84
|
| Rate for Payer: Medical Associates Commercial |
$44.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.85
|
| Rate for Payer: Midlands Choice Commercial |
$41.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$30.28
|
| Rate for Payer: Oscar Health of IA Commercial |
$44.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.78
|
| Rate for Payer: United Healthcare Commercial |
$53.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.22
|
|
|
Protein C Activity DMCL
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
8037785
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| 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 |
$62.58
|
| Rate for Payer: Amerigroup Medicare |
$62.62
|
| Rate for Payer: Cash Price |
$99.20
|
| 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 |
$62.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.98
|
| Rate for Payer: Medical Associates Commercial |
$93.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.00
|
| Rate for Payer: Midlands Choice Commercial |
$86.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.93
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$62.89
|
| Rate for Payer: Oscar Health of IA Commercial |
$93.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.00
|
| Rate for Payer: United Healthcare Commercial |
$111.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.16
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
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 Antigen DMCL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
8037786
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| 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 |
$49.46
|
| Rate for Payer: Amerigroup Medicare |
$49.49
|
| Rate for Payer: Cash Price |
$78.40
|
| 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 |
$49.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.98
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.00
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.74
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$49.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$73.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$73.50
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
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 Electrophoresis DMCL
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
8037787
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| 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 |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| Rate for Payer: Cash Price |
$83.20
|
| 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 |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$52.75
|
| Rate for Payer: Oscar Health of IA Commercial |
$78.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
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
|
|
