|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
IP
|
$346.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
4863332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$311.40 |
| Rate for Payer: Aetna of IA Commercial |
$311.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.40
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.50
|
| Rate for Payer: Medical Associates Commercial |
$259.50
|
| Rate for Payer: Midlands Choice Commercial |
$242.20
|
| Rate for Payer: United Healthcare Commercial |
$311.40
|
|
|
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 |
$182.56 |
| Max. Negotiated Rate |
$381.80 |
| Rate for Payer: Amerigroup Medicaid |
$184.35
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$182.56
|
| Rate for Payer: Medical Associates Commercial |
$292.50
|
| Rate for Payer: Midlands Choice Commercial |
$273.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$183.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$292.50
|
| Rate for Payer: United Healthcare Commercial |
$255.57
|
| Rate for Payer: Wellmark IA HMO WHPI |
$324.50
|
| Rate for Payer: Wellmark IA PPO |
$381.80
|
|
|
RPR S/N/A/GEN/TRK12.6-20.0CM
|
Facility
|
OP
|
$346.00
|
|
|
Service Code
|
CPT 12005
|
| Hospital Charge Code |
4863332
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$155.70 |
| Max. Negotiated Rate |
$657.60 |
| Rate for Payer: Aetna of IA Commercial |
$311.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.40
|
| Rate for Payer: Aetna of IA Medicare |
$197.22
|
| Rate for Payer: Amerigroup Medicaid |
$199.57
|
| Rate for Payer: Amerigroup Medicare |
$157.26
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$155.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$197.64
|
| Rate for Payer: Medical Associates Commercial |
$259.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$155.70
|
| Rate for Payer: Midlands Choice Commercial |
$242.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$200.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$179.06
|
| Rate for Payer: United Healthcare Commercial |
$311.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$204.14
|
| Rate for Payer: Wellmark IA HMO WHPI |
$596.98
|
| Rate for Payer: Wellmark IA PPO |
$657.60
|
|
|
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 |
$238.67 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Amerigroup Medicaid |
$241.01
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$238.67
|
| Rate for Payer: Medical Associates Commercial |
$472.50
|
| Rate for Payer: Midlands Choice Commercial |
$441.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$239.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$472.50
|
| Rate for Payer: United Healthcare Commercial |
$301.68
|
| Rate for Payer: Wellmark IA HMO WHPI |
$374.40
|
| Rate for Payer: Wellmark IA PPO |
$440.40
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
4863333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$353.50 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Aetna of IA Commercial |
$454.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$454.50
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.75
|
| Rate for Payer: Medical Associates Commercial |
$378.75
|
| Rate for Payer: Midlands Choice Commercial |
$353.50
|
| Rate for Payer: United Healthcare Commercial |
$454.50
|
|
|
RPR S/N/A/GEN/TRK20.1-30.0CM
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 12006
|
| Hospital Charge Code |
4863333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$227.25 |
| Max. Negotiated Rate |
$657.60 |
| Rate for Payer: Aetna of IA Commercial |
$454.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$454.50
|
| Rate for Payer: Aetna of IA Medicare |
$287.85
|
| Rate for Payer: Amerigroup Medicaid |
$291.28
|
| Rate for Payer: Amerigroup Medicare |
$229.52
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$227.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$288.46
|
| Rate for Payer: Medical Associates Commercial |
$378.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$227.25
|
| Rate for Payer: Midlands Choice Commercial |
$353.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$292.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$261.34
|
| Rate for Payer: United Healthcare Commercial |
$454.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$297.95
|
| Rate for Payer: Wellmark IA HMO WHPI |
$596.98
|
| Rate for Payer: Wellmark IA PPO |
$657.60
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
4863331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
|
|
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 |
$146.84 |
| Max. Negotiated Rate |
$286.70 |
| Rate for Payer: Amerigroup Medicaid |
$148.28
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$146.84
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$147.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$236.25
|
| Rate for Payer: United Healthcare Commercial |
$193.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$243.70
|
| Rate for Payer: Wellmark IA PPO |
$286.70
|
|
|
RPR S/N/AX/GEN/TRK7.6-12.5CM
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 12004
|
| Hospital Charge Code |
4863331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$657.60 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Aetna of IA Medicare |
$216.60
|
| Rate for Payer: Amerigroup Medicaid |
$219.18
|
| Rate for Payer: Amerigroup Medicare |
$172.71
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$171.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$217.06
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$171.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$196.65
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$224.20
|
| Rate for Payer: Wellmark IA HMO WHPI |
$596.98
|
| Rate for Payer: Wellmark IA PPO |
$657.60
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
4863328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$657.60 |
| Rate for Payer: Aetna of IA Commercial |
$273.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$273.60
|
| Rate for Payer: Aetna of IA Medicare |
$173.28
|
| Rate for Payer: Amerigroup Medicaid |
$175.35
|
| Rate for Payer: Amerigroup Medicare |
$138.17
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$136.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$173.64
|
| Rate for Payer: Medical Associates Commercial |
$228.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$136.80
|
| Rate for Payer: Midlands Choice Commercial |
$212.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$176.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$157.32
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$179.36
|
| Rate for Payer: Wellmark IA HMO WHPI |
$596.98
|
| Rate for Payer: Wellmark IA PPO |
$657.60
|
|
|
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 |
$111.89 |
| Max. Negotiated Rate |
$203.10 |
| Rate for Payer: Amerigroup Medicaid |
$112.99
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.89
|
| Rate for Payer: Medical Associates Commercial |
$180.00
|
| Rate for Payer: Midlands Choice Commercial |
$168.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$112.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$180.00
|
| Rate for Payer: United Healthcare Commercial |
$135.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$172.60
|
| Rate for Payer: Wellmark IA PPO |
$203.10
|
|
|
RPR S/N/AX/GEN/TRNK 2.5CM/<
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
4863328
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna of IA Commercial |
$273.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$273.60
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$228.00
|
| Rate for Payer: Medical Associates Commercial |
$228.00
|
| Rate for Payer: Midlands Choice Commercial |
$212.80
|
| Rate for Payer: United Healthcare Commercial |
$273.60
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
IP
|
$355.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
4863330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.50 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
|
|
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 |
$123.11 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Amerigroup Medicaid |
$124.32
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$123.11
|
| Rate for Payer: Medical Associates Commercial |
$210.00
|
| Rate for Payer: Midlands Choice Commercial |
$196.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$123.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$210.00
|
| Rate for Payer: United Healthcare Commercial |
$165.49
|
| Rate for Payer: Wellmark IA HMO WHPI |
$209.10
|
| Rate for Payer: Wellmark IA PPO |
$246.00
|
|
|
RPR S/N/AX/GEN/TRNK2.6-7.5CM
|
Facility
|
OP
|
$355.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
4863330
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.75 |
| Max. Negotiated Rate |
$657.60 |
| Rate for Payer: Aetna of IA Commercial |
$319.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$319.50
|
| Rate for Payer: Aetna of IA Medicare |
$202.35
|
| Rate for Payer: Amerigroup Medicaid |
$204.76
|
| Rate for Payer: Amerigroup Medicare |
$161.35
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$266.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$159.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$202.78
|
| Rate for Payer: Medical Associates Commercial |
$266.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$159.75
|
| Rate for Payer: Midlands Choice Commercial |
$248.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$205.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$183.71
|
| Rate for Payer: United Healthcare Commercial |
$319.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$209.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$596.98
|
| Rate for Payer: Wellmark IA PPO |
$657.60
|
|
|
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 |
$34.03 |
| 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 |
$65.76
|
| Rate for Payer: Amerigroup Medicare |
$51.81
|
| 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 |
$51.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.12
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.30
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$59.00
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
Rubella IgG Antibody DMCL
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
8037798
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$68.06
|
| Rate for Payer: Amerigroup Medicare |
$53.63
|
| 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 |
$53.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.40
|
| Rate for Payer: Medical Associates Commercial |
$88.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.10
|
| Rate for Payer: Midlands Choice Commercial |
$82.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.06
|
| Rate for Payer: United Healthcare Commercial |
$106.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.62
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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
|
|
|
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
|
|
|
Rubeola IgG Antibody DMCL
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
8037799
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$70.95
|
| Rate for Payer: Amerigroup Medicare |
$55.90
|
| 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 |
$55.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.26
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.35
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.65
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.57
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
Rupture of Membranes
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
4022813
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Aetna of IA Commercial |
$153.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$127.50
|
| Rate for Payer: Medical Associates Commercial |
$127.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.00
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
|
|
Rupture of Membranes
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
4022813
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$304.59 |
| Rate for Payer: Aetna of IA Commercial |
$153.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$153.00
|
| Rate for Payer: Aetna of IA Medicare |
$96.90
|
| Rate for Payer: Amerigroup Medicaid |
$98.06
|
| Rate for Payer: Amerigroup Medicare |
$77.26
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Cash Price |
$136.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$127.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$76.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.10
|
| Rate for Payer: Medical Associates Commercial |
$127.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.50
|
| Rate for Payer: Midlands Choice Commercial |
$119.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$98.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.98
|
| Rate for Payer: United Healthcare Commercial |
$153.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$100.30
|
| Rate for Payer: Wellmark IA HMO WHPI |
$276.51
|
| Rate for Payer: Wellmark IA PPO |
$304.59
|
|
|
sacubitril-valsartan 24 mg-26 mg Tab[VDMC]
|
Facility
|
OP
|
$45.22
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11856650
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.35 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna of IA Commercial |
$40.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.70
|
| Rate for Payer: Aetna of IA Medicare |
$25.77
|
| Rate for Payer: Amerigroup Medicaid |
$26.08
|
| Rate for Payer: Amerigroup Medicare |
$20.55
|
| Rate for Payer: Cash Price |
$36.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.91
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.83
|
| Rate for Payer: Medical Associates Commercial |
$33.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.35
|
| Rate for Payer: Midlands Choice Commercial |
$31.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.40
|
| Rate for Payer: United Healthcare Commercial |
$40.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.68
|
|
|
sacubitril-valsartan 24 mg-26 mg Tab[VDMC]
|
Facility
|
IP
|
$45.22
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11856650
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.65 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna of IA Commercial |
$40.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.70
|
| Rate for Payer: Cash Price |
$36.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.91
|
| Rate for Payer: Medical Associates Commercial |
$33.91
|
| Rate for Payer: Midlands Choice Commercial |
$31.65
|
| Rate for Payer: United Healthcare Commercial |
$40.70
|
|
