|
trospium chloride 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna of IA Commercial |
$1.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.59
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.32
|
| Rate for Payer: Medical Associates Commercial |
$1.32
|
| Rate for Payer: Midlands Choice Commercial |
$1.24
|
| Rate for Payer: United Healthcare Commercial |
$1.59
|
|
|
trospium chloride 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna of IA Commercial |
$1.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.59
|
| Rate for Payer: Aetna of IA Medicare |
$1.01
|
| Rate for Payer: Amerigroup Medicaid |
$1.02
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.01
|
| Rate for Payer: Medical Associates Commercial |
$1.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.79
|
| Rate for Payer: Midlands Choice Commercial |
$1.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.91
|
| Rate for Payer: United Healthcare Commercial |
$1.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.04
|
|
|
trypan blue Ophth 0.06% Sol [VDMC]
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
NDC 68803-0612-10
|
| Hospital Charge Code |
10439906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$214.90 |
| Max. Negotiated Rate |
$276.30 |
| Rate for Payer: Aetna of IA Commercial |
$276.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$276.30
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$230.25
|
| Rate for Payer: Medical Associates Commercial |
$230.25
|
| Rate for Payer: Midlands Choice Commercial |
$214.90
|
| Rate for Payer: United Healthcare Commercial |
$276.30
|
|
|
trypan blue Ophth 0.06% Sol [VDMC]
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
NDC 68803-0612-10
|
| Hospital Charge Code |
10439906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$138.15 |
| Max. Negotiated Rate |
$276.30 |
| Rate for Payer: Aetna of IA Commercial |
$276.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$276.30
|
| Rate for Payer: Aetna of IA Medicare |
$174.99
|
| Rate for Payer: Amerigroup Medicaid |
$177.08
|
| Rate for Payer: Amerigroup Medicare |
$139.53
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$230.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$138.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$175.36
|
| Rate for Payer: Medical Associates Commercial |
$230.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$138.15
|
| Rate for Payer: Midlands Choice Commercial |
$214.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$177.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.87
|
| Rate for Payer: United Healthcare Commercial |
$276.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$181.13
|
|
|
Tryptase DMCL
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
8037820
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Aetna of IA Medicare |
$70.11
|
| Rate for Payer: Amerigroup Medicaid |
$70.95
|
| Rate for Payer: Amerigroup Medicare |
$55.90
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.26
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.35
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.65
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.57
|
|
|
Tryptase DMCL
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
8037820
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
|
|
TSH
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
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
|
|
|
TSH
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.65 |
| 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 |
$79.02
|
| Rate for Payer: Amerigroup Medicare |
$62.27
|
| 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 |
$61.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.25
|
| Rate for Payer: Medical Associates Commercial |
$102.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.65
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$70.90
|
| Rate for Payer: United Healthcare Commercial |
$123.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$80.83
|
|
|
tuberculin purified protein derivative 5 TU/0.1 mL ID MDV Sol [VDMC]
|
Facility
|
OP
|
$60.51
|
|
|
Service Code
|
NDC 49281-0752-21
|
| Hospital Charge Code |
10426843
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$54.46 |
| Rate for Payer: Aetna of IA Commercial |
$54.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.46
|
| Rate for Payer: Aetna of IA Medicare |
$34.49
|
| Rate for Payer: Amerigroup Medicaid |
$34.90
|
| Rate for Payer: Amerigroup Medicare |
$27.50
|
| Rate for Payer: Cash Price |
$48.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.56
|
| Rate for Payer: Medical Associates Commercial |
$45.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.23
|
| Rate for Payer: Midlands Choice Commercial |
$42.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.31
|
| Rate for Payer: United Healthcare Commercial |
$54.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.70
|
|
|
tuberculin purified protein derivative 5 TU/0.1 mL ID MDV Sol [VDMC]
|
Facility
|
IP
|
$60.51
|
|
|
Service Code
|
NDC 49281-0752-21
|
| Hospital Charge Code |
10426843
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.36 |
| Max. Negotiated Rate |
$54.46 |
| Rate for Payer: Aetna of IA Commercial |
$54.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.46
|
| Rate for Payer: Cash Price |
$48.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.38
|
| Rate for Payer: Medical Associates Commercial |
$45.38
|
| Rate for Payer: Midlands Choice Commercial |
$42.36
|
| Rate for Payer: United Healthcare Commercial |
$54.46
|
|
|
ULTRASOUND PER 15 MIN
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
1373448
|
|
Hospital Revenue Code
|
430
|
| 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
|
|
|
ULTRASOUND PER 15 MIN
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
1373448
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.55 |
| 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 |
$57.10
|
| Rate for Payer: Amerigroup Medicare |
$45.00
|
| 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 |
$44.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.55
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.55
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.23
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
|
|
ULTRASOUND PER 15 MIN APPLICATION
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
1374021
|
|
Hospital Revenue Code
|
420
|
| 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
|
|
|
ULTRASOUND PER 15 MIN APPLICATION
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
1374021
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$44.55 |
| 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 |
$57.10
|
| Rate for Payer: Amerigroup Medicare |
$45.00
|
| 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 |
$44.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.55
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.55
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.23
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
|
|
umeclidinium 62.5 mcg (0.0625 mg)/inh Pow [VDMC]
|
Facility
|
IP
|
$162.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11223551
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$146.05 |
| Rate for Payer: Aetna of IA Commercial |
$146.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.05
|
| Rate for Payer: Cash Price |
$129.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$121.71
|
| Rate for Payer: Medical Associates Commercial |
$121.71
|
| Rate for Payer: Midlands Choice Commercial |
$113.60
|
| Rate for Payer: United Healthcare Commercial |
$146.05
|
|
|
umeclidinium 62.5 mcg (0.0625 mg)/inh Pow [VDMC]
|
Facility
|
OP
|
$162.28
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11223551
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$73.03 |
| Max. Negotiated Rate |
$146.05 |
| Rate for Payer: Aetna of IA Commercial |
$146.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$146.05
|
| Rate for Payer: Aetna of IA Medicare |
$92.50
|
| Rate for Payer: Amerigroup Medicaid |
$93.60
|
| Rate for Payer: Amerigroup Medicare |
$73.76
|
| Rate for Payer: Cash Price |
$129.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$121.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$92.69
|
| Rate for Payer: Medical Associates Commercial |
$121.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.03
|
| Rate for Payer: Midlands Choice Commercial |
$113.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$94.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.98
|
| Rate for Payer: United Healthcare Commercial |
$146.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$95.75
|
|
|
U PLATE SMALL
|
Facility
|
IP
|
$2,970.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8968466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,079.00 |
| Max. Negotiated Rate |
$2,673.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,673.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,673.00
|
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,227.50
|
| Rate for Payer: Medical Associates Commercial |
$2,227.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,079.00
|
| Rate for Payer: United Healthcare Commercial |
$2,673.00
|
|
|
U PLATE SMALL
|
Facility
|
OP
|
$2,970.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8968466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,336.50 |
| Max. Negotiated Rate |
$2,673.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,673.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,673.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,692.90
|
| Rate for Payer: Amerigroup Medicaid |
$1,713.10
|
| Rate for Payer: Amerigroup Medicare |
$1,349.87
|
| Rate for Payer: Cash Price |
$2,376.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,227.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,336.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,696.46
|
| Rate for Payer: Medical Associates Commercial |
$2,227.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,336.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,079.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,721.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,536.97
|
| Rate for Payer: United Healthcare Commercial |
$2,673.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,752.30
|
|
|
Urea topical 20% Cream 85 gram [VDMC]
|
Facility
|
IP
|
$25.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
17100134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.12 |
| Max. Negotiated Rate |
$23.29 |
| Rate for Payer: Aetna of IA Commercial |
$23.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.29
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.41
|
| Rate for Payer: Medical Associates Commercial |
$19.41
|
| Rate for Payer: Midlands Choice Commercial |
$18.12
|
| Rate for Payer: United Healthcare Commercial |
$23.29
|
|
|
Urea topical 20% Cream 85 gram [VDMC]
|
Facility
|
OP
|
$25.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
17100134
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$23.29 |
| Rate for Payer: Aetna of IA Commercial |
$23.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.29
|
| Rate for Payer: Aetna of IA Medicare |
$14.75
|
| Rate for Payer: Amerigroup Medicaid |
$14.93
|
| Rate for Payer: Amerigroup Medicare |
$11.76
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.78
|
| Rate for Payer: Medical Associates Commercial |
$19.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.65
|
| Rate for Payer: Midlands Choice Commercial |
$18.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$23.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.27
|
|
|
URIC ACID
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
633858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna of IA Commercial |
$41.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.50
|
| Rate for Payer: Medical Associates Commercial |
$34.50
|
| Rate for Payer: Midlands Choice Commercial |
$32.20
|
| Rate for Payer: United Healthcare Commercial |
$41.40
|
|
|
URIC ACID
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
633858
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna of IA Commercial |
$41.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$41.40
|
| Rate for Payer: Aetna of IA Medicare |
$26.22
|
| Rate for Payer: Amerigroup Medicaid |
$26.53
|
| Rate for Payer: Amerigroup Medicare |
$20.91
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$34.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.28
|
| Rate for Payer: Medical Associates Commercial |
$34.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.70
|
| Rate for Payer: Midlands Choice Commercial |
$32.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$41.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.14
|
|
|
Uric Acid Urine Timed DMCL
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
8037740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$27.45 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$35.18
|
| Rate for Payer: Amerigroup Medicare |
$27.72
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.84
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.45
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.57
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
|
|
Uric Acid Urine Timed DMCL
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
8037740
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
URINALYSIS BY DIPSTICK, AUTO W/O MICRO
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
4006797
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Aetna of IA Commercial |
$27.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.90
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.25
|
| Rate for Payer: Medical Associates Commercial |
$23.25
|
| Rate for Payer: Midlands Choice Commercial |
$21.70
|
| Rate for Payer: United Healthcare Commercial |
$27.90
|
|
