|
ANKLE PLATES 12 HOLE CONTOURED VL GRIDLOCK FIBULA PLATE
|
Facility
|
OP
|
$2,052.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8831363
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.40 |
| 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: Aetna of IA Medicare |
$1,169.64
|
| Rate for Payer: Amerigroup Medicaid |
$1,183.59
|
| Rate for Payer: Amerigroup Medicare |
$932.63
|
| 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 |
$923.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,172.10
|
| Rate for Payer: Medical Associates Commercial |
$1,539.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$923.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,436.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,189.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,061.91
|
| Rate for Payer: United Healthcare Commercial |
$1,846.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,210.68
|
|
|
ANTIBODY SCREEN GEL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
4024782
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.85 |
| 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: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$42.11
|
| Rate for Payer: Amerigroup Medicare |
$33.18
|
| 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 |
$32.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.70
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.85
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.78
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
| Rate for Payer: Wellmark IA HMO WHPI |
$50.34
|
| Rate for Payer: Wellmark IA PPO |
$55.45
|
|
|
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 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
|
|
|
Antibody Screen Tube DMCL
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
8037495
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.85 |
| 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: Aetna of IA Medicare |
$41.61
|
| Rate for Payer: Amerigroup Medicaid |
$42.11
|
| Rate for Payer: Amerigroup Medicare |
$33.18
|
| 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 |
$32.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.70
|
| Rate for Payer: Medical Associates Commercial |
$54.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.85
|
| Rate for Payer: Midlands Choice Commercial |
$51.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.78
|
| Rate for Payer: United Healthcare Commercial |
$65.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.07
|
| Rate for Payer: Wellmark IA HMO WHPI |
$50.34
|
| Rate for Payer: Wellmark IA PPO |
$55.45
|
|
|
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
|
|
|
ANTICARDIOLIPIN
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 86147
|
| Hospital Charge Code |
8093924
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$80.75
|
| Rate for Payer: Amerigroup Medicare |
$63.63
|
| 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 |
$63.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.97
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$72.45
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.60
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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 |
$41.83 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
.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 |
$40.95 |
| 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 |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$41.36
|
| 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 |
$40.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.95
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.09
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.69
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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 |
$41.83 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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 Titer DMCL
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 86039
|
| Hospital Charge Code |
8037497
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.95 |
| 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 |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$41.36
|
| 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 |
$40.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.95
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.09
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.69
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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 |
$28.80 |
| 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: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$36.92
|
| Rate for Payer: Amerigroup Medicare |
$29.09
|
| 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 |
$28.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.56
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.80
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
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
|
|
|
ANTIPLATELET ANTIBODY
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
8093925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$100.94
|
| Rate for Payer: Amerigroup Medicare |
$79.54
|
| 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 |
$78.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$99.96
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$101.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$90.56
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
Antistreptolysin O DMCL
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
8037499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.50 |
| 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 |
$40.38
|
| Rate for Payer: Amerigroup Medicare |
$31.82
|
| 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 |
$31.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39.98
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$36.22
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.30
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
8037482
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.07 |
| 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 |
$59.41
|
| Rate for Payer: Amerigroup Medicare |
$46.81
|
| 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 |
$46.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.83
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.35
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.30
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.77
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
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 Xa Heparin UFH DMCL
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
8818432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.10 |
| 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 |
$33.45
|
| Rate for Payer: Amerigroup Medicare |
$26.36
|
| 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 |
$26.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.13
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.10
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.02
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
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
|
|
