|
THP phenazopyridine 200 mg 6 tabs
|
Facility
IP
|
$18.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43740173
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna of IA Commercial |
$16.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.56
|
| Rate for Payer: Cash Price |
$14.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.80
|
| Rate for Payer: Medical Associates Commercial |
$13.80
|
| Rate for Payer: Midlands Choice Commercial |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.56
|
|
|
THP promethazine/codeine 6.25/10mg/5mL syrup
|
Facility
OP
|
$11.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700187
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Aetna of IA Commercial |
$10.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.05
|
| Rate for Payer: Aetna of IA Medicare |
$6.37
|
| Rate for Payer: Amerigroup Medicaid |
$5.64
|
| Rate for Payer: Amerigroup Medicare |
$5.64
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.58
|
| Rate for Payer: Medical Associates Commercial |
$8.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.58
|
| Rate for Payer: Midlands Choice Commercial |
$7.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$8.38
|
| Rate for Payer: United Healthcare Commercial |
$10.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.59
|
|
|
THP promethazine/codeine 6.25/10mg/5mL syrup
|
Facility
IP
|
$11.17
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700187
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Aetna of IA Commercial |
$10.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.05
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.38
|
| Rate for Payer: Medical Associates Commercial |
$8.38
|
| Rate for Payer: Midlands Choice Commercial |
$7.82
|
| Rate for Payer: United Healthcare Commercial |
$10.05
|
|
|
THP sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Sus 30 mL
|
Facility
IP
|
$32.73
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43711283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$29.46 |
| Rate for Payer: Aetna of IA Commercial |
$29.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.46
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.55
|
| Rate for Payer: Medical Associates Commercial |
$24.55
|
| Rate for Payer: Midlands Choice Commercial |
$22.91
|
| Rate for Payer: United Healthcare Commercial |
$29.46
|
|
|
THP sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Sus 30 mL
|
Facility
OP
|
$32.73
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43711283
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$29.46 |
| Rate for Payer: Aetna of IA Commercial |
$29.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.46
|
| Rate for Payer: Aetna of IA Medicare |
$18.66
|
| Rate for Payer: Amerigroup Medicaid |
$16.52
|
| Rate for Payer: Amerigroup Medicare |
$16.53
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.36
|
| Rate for Payer: Medical Associates Commercial |
$24.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.36
|
| Rate for Payer: Midlands Choice Commercial |
$22.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.55
|
| Rate for Payer: United Healthcare Commercial |
$29.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.31
|
|
|
THP sulfamethoxazole-trimethoprim DS 800 mg/160 mg 6 Tablet
|
Facility
OP
|
$13.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43764071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Aetna of IA Commercial |
$12.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.24
|
| Rate for Payer: Aetna of IA Medicare |
$7.75
|
| Rate for Payer: Amerigroup Medicaid |
$6.86
|
| Rate for Payer: Amerigroup Medicare |
$6.87
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.80
|
| Rate for Payer: Medical Associates Commercial |
$10.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.80
|
| Rate for Payer: Midlands Choice Commercial |
$9.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.20
|
| Rate for Payer: United Healthcare Commercial |
$12.24
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.02
|
|
|
THP sulfamethoxazole-trimethoprim DS 800 mg/160 mg 6 Tablet
|
Facility
IP
|
$13.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43764071
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Aetna of IA Commercial |
$12.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.24
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.20
|
| Rate for Payer: Medical Associates Commercial |
$10.20
|
| Rate for Payer: Midlands Choice Commercial |
$9.52
|
| Rate for Payer: United Healthcare Commercial |
$12.24
|
|
|
THP tramadol 50 mg tab
|
Facility
OP
|
$11.08
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700106
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.54 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Aetna of IA Commercial |
$9.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.97
|
| Rate for Payer: Aetna of IA Medicare |
$6.32
|
| Rate for Payer: Amerigroup Medicaid |
$5.59
|
| Rate for Payer: Amerigroup Medicare |
$5.60
|
| Rate for Payer: Cash Price |
$8.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.54
|
| Rate for Payer: Medical Associates Commercial |
$8.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.54
|
| Rate for Payer: Midlands Choice Commercial |
$7.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$8.31
|
| Rate for Payer: United Healthcare Commercial |
$9.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.54
|
|
|
THP tramadol 50 mg tab
|
Facility
IP
|
$11.08
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700106
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Aetna of IA Commercial |
$9.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.97
|
| Rate for Payer: Cash Price |
$8.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.31
|
| Rate for Payer: Medical Associates Commercial |
$8.31
|
| Rate for Payer: Midlands Choice Commercial |
$7.76
|
| Rate for Payer: United Healthcare Commercial |
$9.97
|
|
|
THROAT CULTURE
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633905
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
|
|
THROAT CULTURE
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633905
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Aetna of IA Medicare |
$59.85
|
| Rate for Payer: Amerigroup Medicaid |
$52.99
|
| Rate for Payer: Amerigroup Medicare |
$53.02
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.48
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.50
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.75
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.95
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
THROMBIN TIME
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
8093945
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna of IA Commercial |
$49.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.50
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.25
|
| Rate for Payer: Medical Associates Commercial |
$41.25
|
| Rate for Payer: Midlands Choice Commercial |
$38.50
|
| Rate for Payer: United Healthcare Commercial |
$49.50
|
|
|
THROMBIN TIME
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
8093945
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna of IA Commercial |
$49.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.50
|
| Rate for Payer: Aetna of IA Medicare |
$31.35
|
| Rate for Payer: Amerigroup Medicaid |
$27.76
|
| Rate for Payer: Amerigroup Medicare |
$27.78
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.49
|
| Rate for Payer: Medical Associates Commercial |
$41.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.50
|
| Rate for Payer: Midlands Choice Commercial |
$38.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.25
|
| Rate for Payer: United Healthcare Commercial |
$49.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.45
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
Thyroglobulin Antibody DMCL
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
8037812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
|
|
Thyroglobulin Antibody DMCL
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
8037812
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Aetna of IA Medicare |
$74.10
|
| Rate for Payer: Amerigroup Medicaid |
$65.61
|
| Rate for Payer: Amerigroup Medicare |
$65.65
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$65.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.97
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.00
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$97.50
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.70
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
thyroid desiccated 30 mg Tab PORK
|
Facility
IP
|
$3.15
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna of IA Commercial |
$2.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.84
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.36
|
| Rate for Payer: Medical Associates Commercial |
$2.36
|
| Rate for Payer: Midlands Choice Commercial |
$2.20
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
|
|
thyroid desiccated 30 mg Tab PORK
|
Facility
OP
|
$3.15
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700370
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna of IA Commercial |
$2.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.84
|
| Rate for Payer: Aetna of IA Medicare |
$1.80
|
| Rate for Payer: Amerigroup Medicaid |
$1.59
|
| Rate for Payer: Amerigroup Medicare |
$1.59
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.57
|
| Rate for Payer: Medical Associates Commercial |
$2.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.58
|
| Rate for Payer: Midlands Choice Commercial |
$2.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.36
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.86
|
|
|
Thyroid, Parathyroid and Thyroglossal Procedures With CC
|
Facility
IP
|
$16,186.84
|
|
|
Service Code
|
MS-DRG 626
|
| Hospital Charge Code |
418
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,186.84 |
| Rate for Payer: Amerigroup Medicaid |
$16,108.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15,952.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,186.84
|
|
|
Thyroid, Parathyroid and Thyroglossal Procedures With MCC
|
Facility
IP
|
$27,971.16
|
|
|
Service Code
|
MS-DRG 625
|
| Hospital Charge Code |
417
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$27,971.16 |
| Rate for Payer: Amerigroup Medicaid |
$27,836.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27,565.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27,971.16
|
|
|
Thyroid, Parathyroid and Thyroglossal Procedures Without CC/MCC
|
Facility
IP
|
$8,078.65
|
|
|
Service Code
|
MS-DRG 627
|
| Hospital Charge Code |
419
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,078.65 |
| Rate for Payer: Amerigroup Medicaid |
$8,039.62
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,961.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,078.65
|
|
|
Thyroid Peroxidase Antibody DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
8037813
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| 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 |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| 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 |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Thyroid Peroxidase Antibody DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
8037813
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
Thyroid Stimulating Hormone DMCL
|
Facility
IP
|
$137.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
8037814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of IA Commercial |
$123.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$123.30
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.75
|
| Rate for Payer: Medical Associates Commercial |
$102.75
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: United Healthcare Commercial |
$123.30
|
|
|
Thyroid Stimulating Hormone DMCL
|
Facility
OP
|
$137.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
8037814
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of IA Commercial |
$123.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$123.30
|
| Rate for Payer: Aetna of IA Medicare |
$78.09
|
| Rate for Payer: Amerigroup Medicaid |
$69.14
|
| Rate for Payer: Amerigroup Medicare |
$69.18
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$68.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$68.47
|
| Rate for Payer: Medical Associates Commercial |
$102.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$68.50
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$69.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.75
|
| Rate for Payer: United Healthcare Commercial |
$123.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$80.83
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Thyroid Stimulating Immunoglobulin
|
Facility
IP
|
$253.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
8398200
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$177.10 |
| Max. Negotiated Rate |
$227.70 |
| Rate for Payer: Aetna of IA Commercial |
$227.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$227.70
|
| Rate for Payer: Cash Price |
$202.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$189.75
|
| Rate for Payer: Medical Associates Commercial |
$189.75
|
| Rate for Payer: Midlands Choice Commercial |
$177.10
|
| Rate for Payer: United Healthcare Commercial |
$227.70
|
|
