|
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: Molina Healthcare Managed Medicare |
$37.03
|
| Rate for Payer: Oscar Health of IA Commercial |
$54.75
|
| 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: Molina Healthcare Managed Medicare |
$71.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$105.00
|
| 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
|
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 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: Molina Healthcare Managed Medicare |
$50.21
|
| Rate for Payer: Oscar Health of IA Commercial |
$74.25
|
| 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 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: Molina Healthcare Managed Medicare |
$46.16
|
| Rate for Payer: Oscar Health of IA Commercial |
$68.25
|
| 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 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 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: Molina Healthcare Managed Medicare |
$50.21
|
| Rate for Payer: Oscar Health of IA Commercial |
$74.25
|
| 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
|
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: Molina Healthcare Managed Medicare |
$46.16
|
| Rate for Payer: Oscar Health of IA Commercial |
$68.25
|
| 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 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
|
|
|
Antiphospholipid Antibody Profile DMCL
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
8037498
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
Antiphospholipid Antibody Profile DMCL
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
8037498
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$32.32
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$32.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$48.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
ANTIPLATELET ANTIBODY
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
8093925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Aetna of IA Medicare |
$99.75
|
| Rate for Payer: Amerigroup Medicaid |
$88.32
|
| Rate for Payer: Amerigroup Medicare |
$88.38
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$87.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.46
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$87.50
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$88.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$88.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$131.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$131.25
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
ANTIPLATELET ANTIBODY
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
8093925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
|
|
Antistreptolysin O DMCL
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
8037499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Aetna of IA Medicare |
$39.90
|
| Rate for Payer: Amerigroup Medicaid |
$35.33
|
| Rate for Payer: Amerigroup Medicare |
$35.35
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.99
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.00
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.52
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$35.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$52.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.50
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.30
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Antistreptolysin O DMCL
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
8037499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
|
|
Anti-Thrombin Antigen DMCL
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
8037482
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
|
|
Anti-Thrombin Antigen DMCL
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
8037482
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Aetna of IA Medicare |
$58.71
|
| Rate for Payer: Amerigroup Medicaid |
$51.98
|
| Rate for Payer: Amerigroup Medicare |
$52.02
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.48
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.50
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.27
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$52.24
|
| Rate for Payer: Oscar Health of IA Commercial |
$77.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.25
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.77
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
Anti Xa Heparin UFH DMCL
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
8818432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$29.27
|
| Rate for Payer: Amerigroup Medicare |
$29.29
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.99
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.44
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$29.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$43.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
Anti Xa Heparin UFH DMCL
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
8818432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
Aortic and Heart Assist Procedures Except Pulsation Balloon With MCC
|
Facility
|
IP
|
$51,371.50
|
|
|
Service Code
|
MS-DRG 268
|
| Hospital Charge Code |
130
|
| Min. Negotiated Rate |
$50,626.99 |
| Max. Negotiated Rate |
$51,371.50 |
| Rate for Payer: Amerigroup Medicaid |
$51,123.33
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50,626.99
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51,371.50
|
|
|
Aortic and Heart Assist Procedures Except Pulsation Balloon Without MCC
|
Facility
|
IP
|
$29,227.05
|
|
|
Service Code
|
MS-DRG 269
|
| Hospital Charge Code |
131
|
| Min. Negotiated Rate |
$28,803.47 |
| Max. Negotiated Rate |
$29,227.05 |
| Rate for Payer: Amerigroup Medicaid |
$29,085.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28,803.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29,227.05
|
|
|
APAP/butalbital/caffeine 325 mg-50 mg-40 mg Tab [VDMC]
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10367413
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna of IA Commercial |
$1.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.39
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.16
|
| Rate for Payer: Medical Associates Commercial |
$1.16
|
| Rate for Payer: Midlands Choice Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
|
