|
ALPHA 1-ANTITRYPSIN
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
8037489
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.55 |
| 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 |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| 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 |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
|
|
ALPHA 1-ANTITRYPSIN
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
8037489
|
|
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
|
|
|
alpha 1-proteinase inhibitor human 1000mg/20ml SDV [VDMC]
|
Facility
|
OP
|
$1,267.36
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
22367300
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$570.31 |
| Max. Negotiated Rate |
$1,140.62 |
| Rate for Payer: Aetna of IA Commercial |
$1,140.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,140.62
|
| Rate for Payer: Aetna of IA Medicare |
$722.40
|
| Rate for Payer: Amerigroup Medicaid |
$731.01
|
| Rate for Payer: Amerigroup Medicare |
$576.02
|
| Rate for Payer: Cash Price |
$1,013.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$950.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$570.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$723.92
|
| Rate for Payer: Medical Associates Commercial |
$950.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$570.31
|
| Rate for Payer: Midlands Choice Commercial |
$887.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$734.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$655.86
|
| Rate for Payer: United Healthcare Commercial |
$1,140.62
|
| Rate for Payer: United Healthcare Managed Medicare |
$747.74
|
|
|
alpha 1-proteinase inhibitor human 1000mg/20ml SDV [VDMC]
|
Facility
|
IP
|
$1,267.36
|
|
|
Service Code
|
HCPCS J0256
|
| Hospital Charge Code |
22367300
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$887.15 |
| Max. Negotiated Rate |
$1,140.62 |
| Rate for Payer: Aetna of IA Commercial |
$1,140.62
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,140.62
|
| Rate for Payer: Cash Price |
$1,013.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$950.52
|
| Rate for Payer: Medical Associates Commercial |
$950.52
|
| Rate for Payer: Midlands Choice Commercial |
$887.15
|
| Rate for Payer: United Healthcare Commercial |
$1,140.62
|
|
|
ALPHA FETOPROTEIN
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
8086832
|
|
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
|
|
|
ALPHA FETOPROTEIN
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
8086832
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.55 |
| 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 |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| 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 |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
|
|
Alpha Fetoprotein Tumor Marker DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
8037491
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.55 |
| 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 |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| 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 |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
|
|
Alpha Fetoprotein Tumor Marker DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
8037491
|
|
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
|
|
|
ALPRAZolam 0.25 mg Tab [VDMC]
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna of IA Commercial |
$2.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.77
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.31
|
| Rate for Payer: Medical Associates Commercial |
$2.31
|
| Rate for Payer: Midlands Choice Commercial |
$2.16
|
| Rate for Payer: United Healthcare Commercial |
$2.77
|
|
|
ALPRAZolam 0.25 mg Tab [VDMC]
|
Facility
|
OP
|
$3.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10364933
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna of IA Commercial |
$2.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.77
|
| Rate for Payer: Aetna of IA Medicare |
$1.76
|
| Rate for Payer: Amerigroup Medicaid |
$1.78
|
| Rate for Payer: Amerigroup Medicare |
$1.40
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.76
|
| Rate for Payer: Medical Associates Commercial |
$2.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.39
|
| Rate for Payer: Midlands Choice Commercial |
$2.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.59
|
| Rate for Payer: United Healthcare Commercial |
$2.77
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.82
|
|
|
ALPRAZolam 0.5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365002
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna of IA Commercial |
$2.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.79
|
| Rate for Payer: Aetna of IA Medicare |
$1.77
|
| Rate for Payer: Amerigroup Medicaid |
$1.79
|
| Rate for Payer: Amerigroup Medicare |
$1.41
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.77
|
| Rate for Payer: Medical Associates Commercial |
$2.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.39
|
| Rate for Payer: Midlands Choice Commercial |
$2.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.60
|
| Rate for Payer: United Healthcare Commercial |
$2.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.83
|
|
|
ALPRAZolam 0.5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365002
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna of IA Commercial |
$2.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.79
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.32
|
| Rate for Payer: Medical Associates Commercial |
$2.32
|
| Rate for Payer: Midlands Choice Commercial |
$2.17
|
| Rate for Payer: United Healthcare Commercial |
$2.79
|
|
|
ALPRAZolam 1 mg Tab [VDMC]
|
Facility
|
IP
|
$3.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365142
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna of IA Commercial |
$2.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.79
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.33
|
| Rate for Payer: Medical Associates Commercial |
$2.33
|
| Rate for Payer: Midlands Choice Commercial |
$2.17
|
| Rate for Payer: United Healthcare Commercial |
$2.79
|
|
|
ALPRAZolam 1 mg Tab [VDMC]
|
Facility
|
OP
|
$3.10
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10365142
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$2.79 |
| Rate for Payer: Aetna of IA Commercial |
$2.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.79
|
| Rate for Payer: Aetna of IA Medicare |
$1.77
|
| Rate for Payer: Amerigroup Medicaid |
$1.79
|
| Rate for Payer: Amerigroup Medicare |
$1.41
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.33
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.77
|
| Rate for Payer: Medical Associates Commercial |
$2.33
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.40
|
| Rate for Payer: Midlands Choice Commercial |
$2.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.61
|
| Rate for Payer: United Healthcare Commercial |
$2.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.83
|
|
|
ALS1 EMERGENCY
|
Facility
|
IP
|
$889.00
|
|
|
Service Code
|
HCPCS A0427 QN
|
| Hospital Charge Code |
5230783
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$622.30 |
| Max. Negotiated Rate |
$800.10 |
| Rate for Payer: Aetna of IA Commercial |
$800.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$800.10
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$666.75
|
| Rate for Payer: Medical Associates Commercial |
$666.75
|
| Rate for Payer: Midlands Choice Commercial |
$622.30
|
| Rate for Payer: United Healthcare Commercial |
$800.10
|
|
|
ALS1 EMERGENCY
|
Facility
|
OP
|
$889.00
|
|
|
Service Code
|
HCPCS A0427 QN
|
| Hospital Charge Code |
5230783
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$400.05 |
| Max. Negotiated Rate |
$800.10 |
| Rate for Payer: Aetna of IA Commercial |
$800.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$800.10
|
| Rate for Payer: Aetna of IA Medicare |
$506.73
|
| Rate for Payer: Amerigroup Medicaid |
$512.78
|
| Rate for Payer: Amerigroup Medicare |
$404.05
|
| Rate for Payer: Cash Price |
$711.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$666.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$400.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$507.80
|
| Rate for Payer: Medical Associates Commercial |
$666.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$400.05
|
| Rate for Payer: Midlands Choice Commercial |
$622.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$515.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$460.06
|
| Rate for Payer: United Healthcare Commercial |
$800.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$755.65
|
|
|
ALS1 NON EMERGENCY
|
Facility
|
OP
|
$464.00
|
|
|
Service Code
|
HCPCS A0426 QN
|
| Hospital Charge Code |
5230782
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$208.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of IA Commercial |
$417.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$417.60
|
| Rate for Payer: Aetna of IA Medicare |
$264.48
|
| Rate for Payer: Amerigroup Medicaid |
$267.64
|
| Rate for Payer: Amerigroup Medicare |
$210.89
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$348.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$208.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$265.04
|
| Rate for Payer: Medical Associates Commercial |
$348.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$208.80
|
| Rate for Payer: Midlands Choice Commercial |
$324.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$268.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$240.12
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$394.40
|
|
|
ALS1 NON EMERGENCY
|
Facility
|
IP
|
$464.00
|
|
|
Service Code
|
HCPCS A0426 QN
|
| Hospital Charge Code |
5230782
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$324.80 |
| Max. Negotiated Rate |
$417.60 |
| Rate for Payer: Aetna of IA Commercial |
$417.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$417.60
|
| Rate for Payer: Cash Price |
$371.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$348.00
|
| Rate for Payer: Medical Associates Commercial |
$348.00
|
| Rate for Payer: Midlands Choice Commercial |
$324.80
|
| Rate for Payer: United Healthcare Commercial |
$417.60
|
|
|
ALS2 EMERGENCY
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
HCPCS A0433 QN
|
| Hospital Charge Code |
5230787
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$534.15 |
| Max. Negotiated Rate |
$1,068.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,068.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,068.30
|
| Rate for Payer: Aetna of IA Medicare |
$676.59
|
| Rate for Payer: Amerigroup Medicaid |
$684.66
|
| Rate for Payer: Amerigroup Medicare |
$539.49
|
| Rate for Payer: Cash Price |
$949.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$890.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$534.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$678.01
|
| Rate for Payer: Medical Associates Commercial |
$890.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$534.15
|
| Rate for Payer: Midlands Choice Commercial |
$830.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$687.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$614.27
|
| Rate for Payer: United Healthcare Commercial |
$1,068.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,008.95
|
|
|
ALS2 EMERGENCY
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
HCPCS A0433 QN
|
| Hospital Charge Code |
5230787
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$830.90 |
| Max. Negotiated Rate |
$1,068.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,068.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,068.30
|
| Rate for Payer: Cash Price |
$949.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$890.25
|
| Rate for Payer: Medical Associates Commercial |
$890.25
|
| Rate for Payer: Midlands Choice Commercial |
$830.90
|
| Rate for Payer: United Healthcare Commercial |
$1,068.30
|
|
|
alteplase 100 mg IV Inj SDV [VDMC]
|
Facility
|
IP
|
$17,084.70
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
10365213
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11,959.29 |
| Max. Negotiated Rate |
$15,376.23 |
| Rate for Payer: Aetna of IA Commercial |
$15,376.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15,376.23
|
| Rate for Payer: Cash Price |
$13,667.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12,813.52
|
| Rate for Payer: Medical Associates Commercial |
$12,813.52
|
| Rate for Payer: Midlands Choice Commercial |
$11,959.29
|
| Rate for Payer: United Healthcare Commercial |
$15,376.23
|
|
|
alteplase 100 mg IV Inj SDV [VDMC]
|
Facility
|
OP
|
$17,084.70
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
10365213
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7,688.11 |
| Max. Negotiated Rate |
$15,376.23 |
| Rate for Payer: Aetna of IA Commercial |
$15,376.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$15,376.23
|
| Rate for Payer: Aetna of IA Medicare |
$9,738.28
|
| Rate for Payer: Amerigroup Medicaid |
$9,854.45
|
| Rate for Payer: Amerigroup Medicare |
$7,765.00
|
| Rate for Payer: Cash Price |
$13,667.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$12,813.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7,688.11
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,758.78
|
| Rate for Payer: Medical Associates Commercial |
$12,813.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$7,688.11
|
| Rate for Payer: Midlands Choice Commercial |
$11,959.29
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,902.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$8,841.33
|
| Rate for Payer: United Healthcare Commercial |
$15,376.23
|
| Rate for Payer: United Healthcare Managed Medicare |
$10,079.97
|
|
|
alteplase 2 mg IV Inj SDV [VDMC]
|
Facility
|
IP
|
$734.76
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
10365280
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$514.33 |
| Max. Negotiated Rate |
$661.28 |
| Rate for Payer: Aetna of IA Commercial |
$661.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$661.28
|
| Rate for Payer: Cash Price |
$587.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$551.07
|
| Rate for Payer: Medical Associates Commercial |
$551.07
|
| Rate for Payer: Midlands Choice Commercial |
$514.33
|
| Rate for Payer: United Healthcare Commercial |
$661.28
|
|
|
alteplase 2 mg IV Inj SDV [VDMC]
|
Facility
|
OP
|
$734.76
|
|
|
Service Code
|
HCPCS J2997
|
| Hospital Charge Code |
10365280
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$330.64 |
| Max. Negotiated Rate |
$661.28 |
| Rate for Payer: Aetna of IA Commercial |
$661.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$661.28
|
| Rate for Payer: Aetna of IA Medicare |
$418.81
|
| Rate for Payer: Amerigroup Medicaid |
$423.81
|
| Rate for Payer: Amerigroup Medicare |
$333.95
|
| Rate for Payer: Cash Price |
$587.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$551.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$330.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$419.69
|
| Rate for Payer: Medical Associates Commercial |
$551.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$330.64
|
| Rate for Payer: Midlands Choice Commercial |
$514.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$425.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$380.24
|
| Rate for Payer: United Healthcare Commercial |
$661.28
|
| Rate for Payer: United Healthcare Managed Medicare |
$433.51
|
|
|
ALT (SGPT)
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
633632
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$45.90 |
| Rate for Payer: Aetna of IA Commercial |
$45.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.90
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.25
|
| Rate for Payer: Medical Associates Commercial |
$38.25
|
| Rate for Payer: Midlands Choice Commercial |
$35.70
|
| Rate for Payer: United Healthcare Commercial |
$45.90
|
|
