|
BEHAV CHNG SMOKING 3-10 MIN
|
Facility
OP
|
$47.00
|
|
| Hospital Charge Code |
4770838
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$23.49 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of IA Commercial |
$42.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.30
|
| Rate for Payer: Aetna of IA Medicare |
$26.79
|
| Rate for Payer: Amerigroup Medicaid |
$23.72
|
| Rate for Payer: Amerigroup Medicare |
$23.74
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.49
|
| Rate for Payer: Medical Associates Commercial |
$35.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.50
|
| Rate for Payer: Midlands Choice Commercial |
$32.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$42.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.73
|
|
|
BEHAV CHNG SMOKING 3-10 MIN
|
Facility
IP
|
$47.00
|
|
| Hospital Charge Code |
4770838
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Aetna of IA Commercial |
$42.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.30
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.25
|
| Rate for Payer: Medical Associates Commercial |
$35.25
|
| Rate for Payer: Midlands Choice Commercial |
$32.90
|
| Rate for Payer: United Healthcare Commercial |
$42.30
|
|
|
Behavioral and Developmental Disorders
|
Facility
IP
|
$5,809.98
|
|
|
Service Code
|
MS-DRG 886
|
| Hospital Charge Code |
616
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,809.98 |
| Rate for Payer: Amerigroup Medicaid |
$5,781.92
|
| 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 |
$5,725.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,809.98
|
|
|
belatacept 250 mg Pow inj SDV
|
Facility
IP
|
$1,897.82
|
|
|
Service Code
|
CPT J0485
|
| Hospital Charge Code |
43700339
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,328.47 |
| Max. Negotiated Rate |
$1,708.04 |
| Rate for Payer: Aetna of IA Commercial |
$1,708.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,708.04
|
| Rate for Payer: Cash Price |
$1,518.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,423.36
|
| Rate for Payer: Medical Associates Commercial |
$1,423.36
|
| Rate for Payer: Midlands Choice Commercial |
$1,328.47
|
| Rate for Payer: United Healthcare Commercial |
$1,708.04
|
|
|
belatacept 250 mg Pow inj SDV
|
Facility
OP
|
$1,897.82
|
|
|
Service Code
|
CPT J0485
|
| Hospital Charge Code |
43700339
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$948.53 |
| Max. Negotiated Rate |
$1,708.04 |
| Rate for Payer: Aetna of IA Commercial |
$1,708.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,708.04
|
| Rate for Payer: Aetna of IA Medicare |
$1,081.76
|
| Rate for Payer: Amerigroup Medicaid |
$957.83
|
| Rate for Payer: Amerigroup Medicare |
$958.40
|
| Rate for Payer: Cash Price |
$1,518.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,423.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$948.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$948.53
|
| Rate for Payer: Medical Associates Commercial |
$1,423.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$948.91
|
| Rate for Payer: Midlands Choice Commercial |
$1,328.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$963.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,423.36
|
| Rate for Payer: United Healthcare Commercial |
$1,708.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,119.71
|
|
|
benazepril 10 mg Tab
|
Facility
OP
|
$2.51
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: Aetna of IA Commercial |
$2.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.26
|
| Rate for Payer: Aetna of IA Medicare |
$1.43
|
| Rate for Payer: Amerigroup Medicaid |
$1.27
|
| Rate for Payer: Amerigroup Medicare |
$1.27
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.25
|
| Rate for Payer: Medical Associates Commercial |
$1.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.26
|
| Rate for Payer: Midlands Choice Commercial |
$1.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.88
|
| Rate for Payer: United Healthcare Commercial |
$2.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.48
|
|
|
benazepril 10 mg Tab
|
Facility
IP
|
$2.51
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701746
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$2.26 |
| Rate for Payer: Aetna of IA Commercial |
$2.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.26
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.88
|
| Rate for Payer: Medical Associates Commercial |
$1.88
|
| Rate for Payer: Midlands Choice Commercial |
$1.76
|
| Rate for Payer: United Healthcare Commercial |
$2.26
|
|
|
Benign Prostatic Hypertrophy With MCC
|
Facility
IP
|
$12,619.94
|
|
|
Service Code
|
MS-DRG 725
|
| Hospital Charge Code |
489
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,619.94 |
| Rate for Payer: Amerigroup Medicaid |
$12,558.98
|
| 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 |
$12,437.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,619.94
|
|
|
Benign Prostatic Hypertrophy Without MCC
|
Facility
IP
|
$5,135.77
|
|
|
Service Code
|
MS-DRG 726
|
| Hospital Charge Code |
490
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,135.77 |
| Rate for Payer: Amerigroup Medicaid |
$5,110.96
|
| 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 |
$5,061.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,135.77
|
|
|
benzocaine-menthol topical 15 mg-3.6 mg Loz
|
Facility
IP
|
$1.53
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
|
|
benzocaine-menthol topical 15 mg-3.6 mg Loz
|
Facility
OP
|
$1.53
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701534
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: Aetna of IA Commercial |
$1.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.38
|
| Rate for Payer: Aetna of IA Medicare |
$0.87
|
| Rate for Payer: Amerigroup Medicaid |
$0.77
|
| Rate for Payer: Amerigroup Medicare |
$0.77
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.15
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.76
|
| Rate for Payer: Medical Associates Commercial |
$1.15
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.77
|
| Rate for Payer: Midlands Choice Commercial |
$1.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.90
|
|
|
Benzoin Topical compound Tincture
|
Facility
IP
|
$20.26
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna of IA Commercial |
$18.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.23
|
| Rate for Payer: Cash Price |
$16.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.20
|
| Rate for Payer: Medical Associates Commercial |
$15.20
|
| Rate for Payer: Midlands Choice Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
|
|
Benzoin Topical compound Tincture
|
Facility
OP
|
$20.26
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700392
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.13 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna of IA Commercial |
$18.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.23
|
| Rate for Payer: Aetna of IA Medicare |
$11.55
|
| Rate for Payer: Amerigroup Medicaid |
$10.23
|
| Rate for Payer: Amerigroup Medicare |
$10.23
|
| Rate for Payer: Cash Price |
$16.21
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.13
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.13
|
| Rate for Payer: Medical Associates Commercial |
$15.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.13
|
| Rate for Payer: Midlands Choice Commercial |
$14.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.20
|
| Rate for Payer: United Healthcare Commercial |
$18.23
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.95
|
|
|
benzonatate 100 mg Cap
|
Facility
OP
|
$2.82
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of IA Commercial |
$2.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.54
|
| Rate for Payer: Aetna of IA Medicare |
$1.61
|
| Rate for Payer: Amerigroup Medicaid |
$1.42
|
| Rate for Payer: Amerigroup Medicare |
$1.42
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.41
|
| Rate for Payer: Medical Associates Commercial |
$2.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.41
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.12
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.66
|
|
|
benzonatate 100 mg Cap
|
Facility
IP
|
$2.82
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701816
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of IA Commercial |
$2.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.54
|
| Rate for Payer: Cash Price |
$2.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.12
|
| Rate for Payer: Medical Associates Commercial |
$2.12
|
| Rate for Payer: Midlands Choice Commercial |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
|
|
benztropine 1 mg/mL 2ml Inj SDV Sol
|
Facility
IP
|
$188.74
|
|
|
Service Code
|
CPT J0515
|
| Hospital Charge Code |
43720711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.12 |
| Max. Negotiated Rate |
$169.87 |
| Rate for Payer: Aetna of IA Commercial |
$169.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.87
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.56
|
| Rate for Payer: Medical Associates Commercial |
$141.56
|
| Rate for Payer: Midlands Choice Commercial |
$132.12
|
| Rate for Payer: United Healthcare Commercial |
$169.87
|
|
|
benztropine 1 mg/mL 2ml Inj SDV Sol
|
Facility
OP
|
$188.74
|
|
|
Service Code
|
CPT J0515
|
| Hospital Charge Code |
43720711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.33 |
| Max. Negotiated Rate |
$169.87 |
| Rate for Payer: Aetna of IA Commercial |
$169.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$169.87
|
| Rate for Payer: Aetna of IA Medicare |
$107.58
|
| Rate for Payer: Amerigroup Medicaid |
$95.26
|
| Rate for Payer: Amerigroup Medicare |
$95.31
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$141.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$94.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$94.33
|
| Rate for Payer: Medical Associates Commercial |
$141.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$94.37
|
| Rate for Payer: Midlands Choice Commercial |
$132.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$95.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$141.56
|
| Rate for Payer: United Healthcare Commercial |
$169.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$111.36
|
|
|
benztropine mesylate 1 mg Tab
|
Facility
OP
|
$2.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of IA Commercial |
$1.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.88
|
| Rate for Payer: Aetna of IA Medicare |
$1.19
|
| Rate for Payer: Amerigroup Medicaid |
$1.05
|
| Rate for Payer: Amerigroup Medicare |
$1.06
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.57
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.04
|
| Rate for Payer: Medical Associates Commercial |
$1.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.04
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.57
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.23
|
|
|
benztropine mesylate 1 mg Tab
|
Facility
IP
|
$2.09
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702691
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of IA Commercial |
$1.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.88
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.57
|
| Rate for Payer: Medical Associates Commercial |
$1.57
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
|
|
Beta 2 Glyco Cardio Ab DMCL
|
Facility
OP
|
$157.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
8037501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Aetna of IA Medicare |
$89.49
|
| Rate for Payer: Amerigroup Medicaid |
$79.24
|
| Rate for Payer: Amerigroup Medicare |
$79.28
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.47
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.50
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$117.75
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Beta 2 Glyco Cardio Ab DMCL
|
Facility
IP
|
$157.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
8037501
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
|
|
BETA 2 GLYCOPROTIEN
|
Facility
IP
|
$157.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
8093927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
|
|
BETA 2 GLYCOPROTIEN
|
Facility
OP
|
$157.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
8093927
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Aetna of IA Medicare |
$89.49
|
| Rate for Payer: Amerigroup Medicaid |
$79.24
|
| Rate for Payer: Amerigroup Medicare |
$79.28
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.47
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.50
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$117.75
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Beta 2 Microglobulin DMCL
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
8037502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Beta 2 Microglobulin DMCL
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
8037502
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
