|
rOPINIRole 0.5 mg Tab [VDMC]
|
Facility
|
IP
|
$2.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10608306
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$1.95 |
| Rate for Payer: Aetna of IA Commercial |
$1.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.95
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.63
|
| Rate for Payer: Medical Associates Commercial |
$1.63
|
| Rate for Payer: Midlands Choice Commercial |
$1.52
|
| Rate for Payer: United Healthcare Commercial |
$1.95
|
|
|
rOPINIRole 1 mg Tab [VDMC]
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419836
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna of IA Commercial |
$1.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.79
|
| Rate for Payer: Aetna of IA Medicare |
$1.13
|
| Rate for Payer: Amerigroup Medicaid |
$1.00
|
| Rate for Payer: Amerigroup Medicare |
$1.00
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.49
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.99
|
| Rate for Payer: Medical Associates Commercial |
$1.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.00
|
| Rate for Payer: Midlands Choice Commercial |
$1.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.01
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.49
|
| Rate for Payer: United Healthcare Commercial |
$1.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.17
|
|
|
rOPINIRole 1 mg Tab [VDMC]
|
Facility
|
IP
|
$1.99
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419836
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$1.79 |
| Rate for Payer: Aetna of IA Commercial |
$1.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.79
|
| Rate for Payer: Cash Price |
$1.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.49
|
| Rate for Payer: Medical Associates Commercial |
$1.49
|
| Rate for Payer: Midlands Choice Commercial |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$1.79
|
|
|
ropivacaine 0.5% 30 mL SDV [VDMC]
|
Facility
|
IP
|
$38.39
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
10440103
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.87 |
| Max. Negotiated Rate |
$34.55 |
| Rate for Payer: Aetna of IA Commercial |
$34.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.55
|
| Rate for Payer: Cash Price |
$30.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.79
|
| Rate for Payer: Medical Associates Commercial |
$28.79
|
| Rate for Payer: Midlands Choice Commercial |
$26.87
|
| Rate for Payer: United Healthcare Commercial |
$34.55
|
|
|
ropivacaine 0.5% 30 mL SDV [VDMC]
|
Facility
|
OP
|
$38.39
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
10440103
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$34.55 |
| Rate for Payer: Aetna of IA Commercial |
$34.55
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$34.55
|
| Rate for Payer: Aetna of IA Medicare |
$21.88
|
| Rate for Payer: Amerigroup Medicaid |
$19.38
|
| Rate for Payer: Amerigroup Medicare |
$19.39
|
| Rate for Payer: Cash Price |
$30.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$28.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.19
|
| Rate for Payer: Medical Associates Commercial |
$28.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.20
|
| Rate for Payer: Midlands Choice Commercial |
$26.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$19.47
|
| Rate for Payer: Oscar Health of IA Commercial |
$28.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.79
|
| Rate for Payer: United Healthcare Commercial |
$34.55
|
| Rate for Payer: United Healthcare Managed Medicare |
$22.65
|
|
|
rosuvastatin 10 mg Tab [VDMC]
|
Facility
|
IP
|
$1.62
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Aetna of IA Commercial |
$1.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.46
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.22
|
| Rate for Payer: Medical Associates Commercial |
$1.22
|
| Rate for Payer: Midlands Choice Commercial |
$1.13
|
| Rate for Payer: United Healthcare Commercial |
$1.46
|
|
|
rosuvastatin 10 mg Tab [VDMC]
|
Facility
|
OP
|
$1.62
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10419905
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Aetna of IA Commercial |
$1.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.46
|
| Rate for Payer: Aetna of IA Medicare |
$0.92
|
| Rate for Payer: Amerigroup Medicaid |
$0.82
|
| Rate for Payer: Amerigroup Medicare |
$0.82
|
| Rate for Payer: Cash Price |
$1.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.81
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.81
|
| Rate for Payer: Medical Associates Commercial |
$1.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.81
|
| Rate for Payer: Midlands Choice Commercial |
$1.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.22
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.96
|
|
|
ROTAVIRUS ANTIGEN DETECTION
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
4024784
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
ROTAVIRUS ANTIGEN DETECTION
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 87425
|
| Hospital Charge Code |
4024784
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| 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 |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
rotavirus vaccine pentavalent Sus UD[VDMC]
|
Facility
|
OP
|
$177.82
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
12453538
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$88.87 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna of IA Commercial |
$160.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$160.04
|
| Rate for Payer: Aetna of IA Medicare |
$101.36
|
| Rate for Payer: Amerigroup Medicaid |
$89.75
|
| Rate for Payer: Amerigroup Medicare |
$89.80
|
| Rate for Payer: Cash Price |
$142.25
|
| Rate for Payer: Cash Price |
$142.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$133.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$88.87
|
| Rate for Payer: Medical Associates Commercial |
$133.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.91
|
| Rate for Payer: Midlands Choice Commercial |
$124.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$90.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$133.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$133.36
|
| Rate for Payer: United Healthcare Commercial |
$160.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$104.91
|
| Rate for Payer: Wellmark IA HMO |
$207.70
|
| Rate for Payer: Wellmark IA PPO |
$228.47
|
|
|
rotavirus vaccine pentavalent Sus UD[VDMC]
|
Facility
|
IP
|
$177.82
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
12453538
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$124.47 |
| Max. Negotiated Rate |
$160.04 |
| Rate for Payer: Aetna of IA Commercial |
$160.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$160.04
|
| Rate for Payer: Cash Price |
$142.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$133.36
|
| Rate for Payer: Medical Associates Commercial |
$133.36
|
| Rate for Payer: Midlands Choice Commercial |
$124.47
|
| Rate for Payer: United Healthcare Commercial |
$160.04
|
|
|
RPR FE/E/EN/L/M 12.6-20.0 CM
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 12016
|
| Hospital Charge Code |
7982835
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$113.47 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Aetna of IA Medicare |
$113.47
|
| Rate for Payer: Amerigroup Medicaid |
$117.33
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$136.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$115.74
|
| Rate for Payer: Medical Associates Commercial |
$204.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$113.47
|
| Rate for Payer: Midlands Choice Commercial |
$472.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$196.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$170.20
|
|
|
RPR F/E/E/N/L/M 2.5 CM/<
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
7982839
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$119.49 |
| Rate for Payer: Aetna of IA Medicare |
$49.54
|
| Rate for Payer: Amerigroup Medicaid |
$51.22
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.53
|
| Rate for Payer: Medical Associates Commercial |
$89.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.54
|
| Rate for Payer: Midlands Choice Commercial |
$119.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$85.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.31
|
|
|
RPR F/E/E/N/L/M 2.6-5.0 CM
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
CPT 12013
|
| Hospital Charge Code |
7982838
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$51.61 |
| Max. Negotiated Rate |
$192.50 |
| Rate for Payer: Aetna of IA Medicare |
$51.61
|
| Rate for Payer: Amerigroup Medicaid |
$53.36
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.93
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.64
|
| Rate for Payer: Medical Associates Commercial |
$92.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.61
|
| Rate for Payer: Midlands Choice Commercial |
$192.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$89.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.42
|
|
|
RPR F/E/E/N/L/M 5.1-7.5 CM
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
CPT 12014
|
| Hospital Charge Code |
7982837
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$66.66 |
| Max. Negotiated Rate |
$308.70 |
| Rate for Payer: Aetna of IA Medicare |
$66.66
|
| Rate for Payer: Amerigroup Medicaid |
$68.93
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Cash Price |
$352.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$79.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.99
|
| Rate for Payer: Medical Associates Commercial |
$119.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$66.66
|
| Rate for Payer: Midlands Choice Commercial |
$308.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$115.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$99.99
|
|
|
RPR F/E/E/N/L/M 7.6-12.5 CM
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
CPT 12015
|
| Hospital Charge Code |
7982836
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$83.67 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of IA Medicare |
$83.67
|
| Rate for Payer: Amerigroup Medicaid |
$86.51
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.34
|
| Rate for Payer: Medical Associates Commercial |
$150.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$83.67
|
| Rate for Payer: Midlands Choice Commercial |
$315.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$144.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$125.50
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Professional
|
Both
|
$390.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
7982841
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$84.24 |
| Max. Negotiated Rate |
$273.00 |
| Rate for Payer: Aetna of IA Medicare |
$84.24
|
| Rate for Payer: Amerigroup Medicaid |
$87.10
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.09
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.92
|
| Rate for Payer: Medical Associates Commercial |
$151.63
|
| Rate for Payer: Medical Associates Managed Medicare |
$84.24
|
| Rate for Payer: Midlands Choice Commercial |
$273.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$145.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$126.36
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Professional
|
Both
|
$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 |
$185.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$103.23
|
| Rate for Payer: Midlands Choice Commercial |
$441.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$178.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$154.84
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Professional
|
Both
|
$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 |
$117.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.54
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$113.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$98.31
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
7982844
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$40.06 |
| Max. Negotiated Rate |
$95.29 |
| 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: 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 |
$72.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.06
|
| Rate for Payer: Midlands Choice Commercial |
$95.29
|
| Rate for Payer: Oscar Health of IA Commercial |
$69.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.09
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
7982843
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$52.58 |
| Max. Negotiated Rate |
$12,002.00 |
| 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: 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 |
$94.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.58
|
| Rate for Payer: Midlands Choice Commercial |
$12,002.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$90.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.87
|
|
|
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: Molina Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$85.50
|
| 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
|
|
|
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
|
|
|
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: Molina Healthcare Managed Medicare |
$59.85
|
| Rate for Payer: Oscar Health of IA Commercial |
$88.50
|
| 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
|
|
|
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
|
|
