|
Angiotensin Converting Enzyme DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 82164
|
| Hospital Charge Code |
8037493
|
|
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
|
|
|
ANKLE PLATE 12 HOLE 1/3 TUBULAR PLATE
|
Facility
OP
|
$1,035.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8823374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.29 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Aetna of IA Commercial |
$931.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$931.50
|
| Rate for Payer: Aetna of IA Medicare |
$589.95
|
| Rate for Payer: Amerigroup Medicaid |
$522.36
|
| Rate for Payer: Amerigroup Medicare |
$522.68
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$776.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$517.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$517.29
|
| Rate for Payer: Medical Associates Commercial |
$776.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$517.50
|
| Rate for Payer: Midlands Choice Commercial |
$724.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$525.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$776.25
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$610.65
|
|
|
ANKLE PLATE 12 HOLE 1/3 TUBULAR PLATE
|
Facility
IP
|
$1,035.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8823374
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.50 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Aetna of IA Commercial |
$931.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$931.50
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$776.25
|
| Rate for Payer: Medical Associates Commercial |
$776.25
|
| Rate for Payer: Midlands Choice Commercial |
$724.50
|
| Rate for Payer: United Healthcare Commercial |
$931.50
|
|
|
ANKLE PLATE 7 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
IP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8823181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
|
|
ANKLE PLATE 7 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
OP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8823181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.59 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,035.64
|
| Rate for Payer: Amerigroup Medicare |
$1,036.26
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,026.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,025.59
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,026.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,041.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,539.00
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
|
ANKLE PLATE 9 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
IP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8868039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
|
|
ANKLE PLATE 9 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
OP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8868039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.59 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,035.64
|
| Rate for Payer: Amerigroup Medicare |
$1,036.26
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,026.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,025.59
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,026.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,041.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,539.00
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
|
ANKLE PLATES 10 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
OP
|
$2,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,079.57 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,944.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,944.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,231.20
|
| Rate for Payer: Amerigroup Medicaid |
$1,090.15
|
| Rate for Payer: Amerigroup Medicare |
$1,090.80
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,620.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,080.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,079.57
|
| Rate for Payer: Medical Associates Commercial |
$1,620.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,080.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,512.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,096.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare Commercial |
$1,944.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,274.40
|
|
|
ANKLE PLATES 10 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
IP
|
$2,160.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8758428
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,512.00 |
| Max. Negotiated Rate |
$1,944.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,944.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,944.00
|
| Rate for Payer: Cash Price |
$1,728.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,620.00
|
| Rate for Payer: Medical Associates Commercial |
$1,620.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,512.00
|
| Rate for Payer: United Healthcare Commercial |
$1,944.00
|
|
|
ANKLE PLATES 12 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
IP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8831363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.40 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
|
|
ANKLE PLATES 12 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
OP
|
$2,052.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8831363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,025.59 |
| Max. Negotiated Rate |
$1,846.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,846.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,846.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,035.64
|
| Rate for Payer: Amerigroup Medicare |
$1,036.26
|
| Rate for Payer: Cash Price |
$1,641.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,539.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,026.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,025.59
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,026.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,041.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,539.00
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
|
ANTIBODY SCREEN GEL
|
Facility
IP
|
$73.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
4024782
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
|
ANTIBODY SCREEN GEL
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
4024782
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$36.84
|
| Rate for Payer: Amerigroup Medicare |
$36.86
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.49
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.75
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
Antibody Screen Tube DMCL
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
8037495
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$107.07 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$36.84
|
| Rate for Payer: Amerigroup Medicare |
$36.86
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.49
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.75
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
Antibody Screen Tube DMCL
|
Facility
IP
|
$73.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
8037495
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna of IA Commercial |
$65.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.70
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.75
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
|
|
ANTICARDIOLIPIN
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
8093924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.97 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of IA Commercial |
$126.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.00
|
| Rate for Payer: Aetna of IA Medicare |
$79.80
|
| Rate for Payer: Amerigroup Medicaid |
$70.66
|
| Rate for Payer: Amerigroup Medicare |
$70.70
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.97
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.60
|
| Rate for Payer: Wellmark IA HMO |
$96.72
|
| Rate for Payer: Wellmark IA PPO |
$106.39
|
|
|
ANTICARDIOLIPIN
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
8093924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of IA Commercial |
$126.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
|
|
Antinuclear Ab Scrn w Rflx ENA and IFA DMCL
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
8755583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$49.97
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.48
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.25
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Antinuclear Ab Scrn w Rflx ENA and IFA DMCL
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
8755583
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
Antinuclear Antibody DMCL
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
8037496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of IA Commercial |
$81.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.90
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$68.25
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
|
|
Antinuclear Antibody DMCL
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
8037496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of IA Commercial |
$81.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.90
|
| Rate for Payer: Aetna of IA Medicare |
$51.87
|
| Rate for Payer: Amerigroup Medicaid |
$45.93
|
| Rate for Payer: Amerigroup Medicare |
$45.96
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$68.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$45.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$45.48
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$68.25
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.69
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Antinuclear Antibody Screen, rflx Confirmation DMCL
|
Facility
IP
|
$99.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
8498872
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
Antinuclear Antibody Screen, rflx Confirmation DMCL
|
Facility
OP
|
$99.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
8498872
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$49.97
|
| Rate for Payer: Amerigroup Medicare |
$50.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.48
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.25
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Antinuclear Antibody Titer DMCL
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
8037497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of IA Commercial |
$81.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.90
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$68.25
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
|
|
Antinuclear Antibody Titer DMCL
|
Facility
OP
|
$91.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
8037497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of IA Commercial |
$81.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.90
|
| Rate for Payer: Aetna of IA Medicare |
$51.87
|
| Rate for Payer: Amerigroup Medicaid |
$45.93
|
| Rate for Payer: Amerigroup Medicare |
$45.96
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$68.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$45.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$45.48
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$68.25
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.69
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
