|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Professional
|
$630.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
7982840
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$103.23 |
| Max. Negotiated Rate |
$441.00 |
| Rate for Payer: Aetna of IA Medicare |
$103.23
|
| Rate for Payer: Amerigroup Medicaid |
$106.74
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$123.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$105.29
|
| Rate for Payer: Medical Associates Commercial |
$196.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.23
|
| Rate for Payer: Midlands Choice Commercial |
$441.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$154.84
|
| Rate for Payer: Wellmark IA HMO |
$220.00
|
| Rate for Payer: Wellmark IA PPO |
$259.00
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Professional
|
$315.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
7982842
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$65.54 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna of IA Medicare |
$65.54
|
| Rate for Payer: Amerigroup Medicaid |
$67.77
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.85
|
| Rate for Payer: Medical Associates Commercial |
$124.53
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.54
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$98.31
|
| Rate for Payer: Wellmark IA HMO |
$138.00
|
| Rate for Payer: Wellmark IA PPO |
$162.00
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Professional
|
$240.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
7982844
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$40.06 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna of IA Medicare |
$40.06
|
| Rate for Payer: Amerigroup Medicaid |
$41.42
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.86
|
| Rate for Payer: Medical Associates Commercial |
$76.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.06
|
| Rate for Payer: Midlands Choice Commercial |
$168.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.09
|
| Rate for Payer: Wellmark IA HMO |
$85.00
|
| Rate for Payer: Wellmark IA PPO |
$100.00
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Professional
|
$280.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
7982843
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.58 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna of IA Medicare |
$52.58
|
| Rate for Payer: Amerigroup Medicaid |
$54.37
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.63
|
| Rate for Payer: Medical Associates Commercial |
$99.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.58
|
| Rate for Payer: Midlands Choice Commercial |
$196.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.87
|
| Rate for Payer: Wellmark IA HMO |
$111.00
|
| Rate for Payer: Wellmark IA PPO |
$131.00
|
|
|
RSV ANTIGEN
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
4064782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
RSV ANTIGEN
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
4064782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Rubella IgG Antibody DMCL
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
8037798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna of IA Commercial |
$106.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.20
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.50
|
| Rate for Payer: Medical Associates Commercial |
$88.50
|
| Rate for Payer: Midlands Choice Commercial |
$82.60
|
| Rate for Payer: United Healthcare Commercial |
$106.20
|
|
|
Rubella IgG Antibody DMCL
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
8037798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna of IA Commercial |
$106.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.20
|
| Rate for Payer: Aetna of IA Medicare |
$67.26
|
| Rate for Payer: Amerigroup Medicaid |
$59.55
|
| Rate for Payer: Amerigroup Medicare |
$59.59
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.98
|
| Rate for Payer: Medical Associates Commercial |
$88.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.00
|
| Rate for Payer: Midlands Choice Commercial |
$82.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$88.50
|
| Rate for Payer: United Healthcare Commercial |
$106.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.62
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Rubeola IgG Antibody DMCL
|
Facility
OP
|
$123.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
8037799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Aetna of IA Medicare |
$70.11
|
| Rate for Payer: Amerigroup Medicaid |
$62.08
|
| Rate for Payer: Amerigroup Medicare |
$62.12
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.48
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.57
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Rubeola IgG Antibody DMCL
|
Facility
IP
|
$123.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
8037799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
|
|
sacubitril-valsartan 24 mg-26 mg Tab
|
Facility
OP
|
$44.14
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Aetna of IA Commercial |
$39.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.73
|
| Rate for Payer: Aetna of IA Medicare |
$25.16
|
| Rate for Payer: Amerigroup Medicaid |
$22.28
|
| Rate for Payer: Amerigroup Medicare |
$22.29
|
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.06
|
| Rate for Payer: Medical Associates Commercial |
$33.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.07
|
| Rate for Payer: Midlands Choice Commercial |
$30.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.10
|
| Rate for Payer: United Healthcare Commercial |
$39.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.04
|
|
|
sacubitril-valsartan 24 mg-26 mg Tab
|
Facility
IP
|
$44.14
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700428
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.90 |
| Max. Negotiated Rate |
$39.73 |
| Rate for Payer: Aetna of IA Commercial |
$39.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.73
|
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.10
|
| Rate for Payer: Medical Associates Commercial |
$33.10
|
| Rate for Payer: Midlands Choice Commercial |
$30.90
|
| Rate for Payer: United Healthcare Commercial |
$39.73
|
|
|
SALICYLATE
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
1503768
|
|
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
|
|
|
SALICYLATE
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT G0480
|
| Hospital Charge Code |
1503768
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.47 |
| 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: 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 |
$102.92
|
| Rate for Payer: Wellmark IA PPO |
$113.21
|
|
|
Salivary Gland Procedures
|
Facility
IP
|
$10,091.43
|
|
|
Service Code
|
MS-DRG 139
|
| Hospital Charge Code |
19
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,091.43 |
| Rate for Payer: Amerigroup Medicaid |
$10,042.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,945.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,091.43
|
|
|
saliva substitutes - Spr
|
Facility
OP
|
$32.12
|
|
|
Service Code
|
CPT A9155
|
| Hospital Charge Code |
43700482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$28.91 |
| Rate for Payer: Aetna of IA Commercial |
$28.91
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.91
|
| Rate for Payer: Aetna of IA Medicare |
$18.31
|
| Rate for Payer: Amerigroup Medicaid |
$16.21
|
| Rate for Payer: Amerigroup Medicare |
$16.22
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.05
|
| Rate for Payer: Medical Associates Commercial |
$24.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.06
|
| Rate for Payer: Midlands Choice Commercial |
$22.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.09
|
| Rate for Payer: United Healthcare Commercial |
$28.91
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.95
|
|
|
saliva substitutes - Spr
|
Facility
IP
|
$32.12
|
|
|
Service Code
|
CPT A9155
|
| Hospital Charge Code |
43700482
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$28.91 |
| Rate for Payer: Aetna of IA Commercial |
$28.91
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.91
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.09
|
| Rate for Payer: Medical Associates Commercial |
$24.09
|
| Rate for Payer: Midlands Choice Commercial |
$22.48
|
| Rate for Payer: United Healthcare Commercial |
$28.91
|
|
|
salsalate 500 mg Tab
|
Facility
IP
|
$2.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of IA Commercial |
$1.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.90
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.58
|
| Rate for Payer: Medical Associates Commercial |
$1.58
|
| Rate for Payer: Midlands Choice Commercial |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
|
|
salsalate 500 mg Tab
|
Facility
OP
|
$2.11
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702767
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of IA Commercial |
$1.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.90
|
| Rate for Payer: Aetna of IA Medicare |
$1.20
|
| Rate for Payer: Amerigroup Medicaid |
$1.06
|
| Rate for Payer: Amerigroup Medicare |
$1.07
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.05
|
| Rate for Payer: Medical Associates Commercial |
$1.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.06
|
| Rate for Payer: Midlands Choice Commercial |
$1.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.58
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.24
|
|
|
SARS-CoV-2 (COVID-19) 12YR+ mRNA-LNP vaccine (cvx 312) [VDMC]
|
Facility
IP
|
$149.50
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
43799938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna of IA Commercial |
$134.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.55
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.12
|
| Rate for Payer: Medical Associates Commercial |
$112.12
|
| Rate for Payer: Midlands Choice Commercial |
$104.65
|
| Rate for Payer: United Healthcare Commercial |
$134.55
|
|
|
SARS-CoV-2 (COVID-19) 12YR+ mRNA-LNP vaccine (cvx 312) [VDMC]
|
Facility
OP
|
$149.50
|
|
|
Service Code
|
CPT 91322
|
| Hospital Charge Code |
43799938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.72 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna of IA Commercial |
$134.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.55
|
| Rate for Payer: Aetna of IA Medicare |
$85.22
|
| Rate for Payer: Amerigroup Medicaid |
$75.45
|
| Rate for Payer: Amerigroup Medicare |
$75.50
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$112.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$74.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.72
|
| Rate for Payer: Medical Associates Commercial |
$112.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.75
|
| Rate for Payer: Midlands Choice Commercial |
$104.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$112.12
|
| Rate for Payer: United Healthcare Commercial |
$134.55
|
| Rate for Payer: United Healthcare Managed Medicare |
$88.20
|
|
|
SARS-CoV-2 (COVID-19) 6M-11YR mRNA-LNP vaccine (cvx 311) [VDMC]
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT 91321
|
| Hospital Charge Code |
43799939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.98 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of IA Commercial |
$75.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.60
|
| Rate for Payer: Aetna of IA Medicare |
$47.88
|
| Rate for Payer: Amerigroup Medicaid |
$42.39
|
| Rate for Payer: Amerigroup Medicare |
$42.42
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.98
|
| Rate for Payer: Medical Associates Commercial |
$63.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$58.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$75.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$49.56
|
|
|
SARS-CoV-2 (COVID-19) 6M-11YR mRNA-LNP vaccine (cvx 311) [VDMC]
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT 91321
|
| Hospital Charge Code |
43799939
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna of IA Commercial |
$75.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$75.60
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.00
|
| Rate for Payer: Medical Associates Commercial |
$63.00
|
| Rate for Payer: Midlands Choice Commercial |
$58.80
|
| Rate for Payer: United Healthcare Commercial |
$75.60
|
|
|
SARS-CoV-2 (COVID-19) BioFire
|
Facility
OP
|
$338.00
|
|
|
Service Code
|
CPT U0004 CS
|
| Hospital Charge Code |
8789912
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Aetna of IA Medicare |
$192.66
|
| Rate for Payer: Amerigroup Medicaid |
$170.59
|
| Rate for Payer: Amerigroup Medicare |
$170.69
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$169.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$168.93
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$169.00
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$171.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$253.50
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$199.42
|
|
|
SARS-CoV-2 (COVID-19) BioFire
|
Facility
IP
|
$338.00
|
|
|
Service Code
|
CPT U0004 CS
|
| Hospital Charge Code |
8789912
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$304.20 |
| Rate for Payer: Aetna of IA Commercial |
$304.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$304.20
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$253.50
|
| Rate for Payer: Medical Associates Commercial |
$253.50
|
| Rate for Payer: Midlands Choice Commercial |
$236.60
|
| Rate for Payer: United Healthcare Commercial |
$304.20
|
|
