|
Beta-hydroxybutyric Acid DMCL
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
8804480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of IA Commercial |
$144.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.00
|
| Rate for Payer: Aetna of IA Medicare |
$91.20
|
| Rate for Payer: Amerigroup Medicaid |
$92.29
|
| Rate for Payer: Amerigroup Medicare |
$72.72
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.39
|
| Rate for Payer: Medical Associates Commercial |
$120.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.00
|
| Rate for Payer: Midlands Choice Commercial |
$112.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$92.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.80
|
| Rate for Payer: United Healthcare Commercial |
$144.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.40
|
|
|
Beta-hydroxybutyric Acid DMCL
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
8804480
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna of IA Commercial |
$144.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.00
|
| Rate for Payer: Medical Associates Commercial |
$120.00
|
| Rate for Payer: Midlands Choice Commercial |
$112.00
|
| Rate for Payer: United Healthcare Commercial |
$144.00
|
|
|
betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL MDV [VDMC]
|
Facility
|
OP
|
$156.52
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
10370222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna of IA Commercial |
$140.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.87
|
| Rate for Payer: Aetna of IA Medicare |
$89.22
|
| Rate for Payer: Amerigroup Medicaid |
$90.28
|
| Rate for Payer: Amerigroup Medicare |
$71.14
|
| Rate for Payer: Cash Price |
$125.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.43
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.40
|
| Rate for Payer: Medical Associates Commercial |
$117.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.43
|
| Rate for Payer: Midlands Choice Commercial |
$109.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$140.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.35
|
|
|
betamethasone acetate-betamethasone sodium phosphate 3 mg-3 mg Inj Susp 5 mL MDV [VDMC]
|
Facility
|
IP
|
$156.52
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
10370222
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$140.87 |
| Rate for Payer: Aetna of IA Commercial |
$140.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.87
|
| Rate for Payer: Cash Price |
$125.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.39
|
| Rate for Payer: Medical Associates Commercial |
$117.39
|
| Rate for Payer: Midlands Choice Commercial |
$109.56
|
| Rate for Payer: United Healthcare Commercial |
$140.87
|
|
|
betamethasone-clotrimazole topical 0.05%-1% Cre 45gm [VDMC]
|
Facility
|
IP
|
$75.61
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222287
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$52.93 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna of IA Commercial |
$68.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.05
|
| Rate for Payer: Cash Price |
$60.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.71
|
| Rate for Payer: Medical Associates Commercial |
$56.71
|
| Rate for Payer: Midlands Choice Commercial |
$52.93
|
| Rate for Payer: United Healthcare Commercial |
$68.05
|
|
|
betamethasone-clotrimazole topical 0.05%-1% Cre 45gm [VDMC]
|
Facility
|
OP
|
$75.61
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222287
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.02 |
| Max. Negotiated Rate |
$68.05 |
| Rate for Payer: Aetna of IA Commercial |
$68.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.05
|
| Rate for Payer: Aetna of IA Medicare |
$43.10
|
| Rate for Payer: Amerigroup Medicaid |
$43.61
|
| Rate for Payer: Amerigroup Medicare |
$34.36
|
| Rate for Payer: Cash Price |
$60.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.71
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.19
|
| Rate for Payer: Medical Associates Commercial |
$56.71
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.02
|
| Rate for Payer: Midlands Choice Commercial |
$52.93
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.13
|
| Rate for Payer: United Healthcare Commercial |
$68.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.61
|
|
|
bicalutamide 50 mg Tab [VDMC]
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370427
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| Rate for Payer: Aetna of IA Medicare |
$0.99
|
| Rate for Payer: Amerigroup Medicaid |
$1.00
|
| Rate for Payer: Amerigroup Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.99
|
| Rate for Payer: Medical Associates Commercial |
$1.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.03
|
|
|
bicalutamide 50 mg Tab [VDMC]
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10370427
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.57 |
| Rate for Payer: Aetna of IA Commercial |
$1.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.57
|
| Rate for Payer: Cash Price |
$1.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.31
|
| Rate for Payer: Medical Associates Commercial |
$1.31
|
| Rate for Payer: Midlands Choice Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$1.57
|
|
|
BIER BLOCK ANESTHESIA
|
Facility
|
IP
|
$422.00
|
|
| Hospital Charge Code |
8059080
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$295.40 |
| Max. Negotiated Rate |
$379.80 |
| Rate for Payer: Aetna of IA Commercial |
$379.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$379.80
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$316.50
|
| Rate for Payer: Medical Associates Commercial |
$316.50
|
| Rate for Payer: Midlands Choice Commercial |
$295.40
|
| Rate for Payer: United Healthcare Commercial |
$379.80
|
|
|
BIER BLOCK ANESTHESIA
|
Facility
|
OP
|
$422.00
|
|
| Hospital Charge Code |
8059080
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$189.90 |
| Max. Negotiated Rate |
$379.80 |
| Rate for Payer: Aetna of IA Commercial |
$379.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$379.80
|
| Rate for Payer: Aetna of IA Medicare |
$240.54
|
| Rate for Payer: Amerigroup Medicaid |
$243.41
|
| Rate for Payer: Amerigroup Medicare |
$191.80
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$316.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$189.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$241.05
|
| Rate for Payer: Medical Associates Commercial |
$316.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$189.90
|
| Rate for Payer: Midlands Choice Commercial |
$295.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$244.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$218.38
|
| Rate for Payer: United Healthcare Commercial |
$379.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$248.98
|
|
|
BILIRUBIN DIRECT
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
633670
|
|
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
|
|
|
BILIRUBIN DIRECT
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
633670
|
|
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
|
|
|
BILIRUBIN DIRECT
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
6312793
|
|
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
|
|
|
BILIRUBIN DIRECT
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 82248
|
| Hospital Charge Code |
6312793
|
|
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
|
|
|
BILIRUBIN TOTAL
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633672
|
|
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
|
|
|
BILIRUBIN TOTAL
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
633672
|
|
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
|
|
|
BILL ABO
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
8015152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
|
|
BILL ABO
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
8015152
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Aetna of IA Commercial |
$46.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.80
|
| Rate for Payer: Aetna of IA Medicare |
$29.64
|
| Rate for Payer: Amerigroup Medicaid |
$29.99
|
| Rate for Payer: Amerigroup Medicare |
$23.63
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$39.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.70
|
| Rate for Payer: Medical Associates Commercial |
$39.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.40
|
| Rate for Payer: Midlands Choice Commercial |
$36.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.91
|
| Rate for Payer: United Healthcare Commercial |
$46.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.68
|
|
|
Bill Alcohol Saliva 82055
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
8100912
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
Bill Alcohol Saliva 82055
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
8100912
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
BILL ANTIBODY ELUTION
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
7829178
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
|
|
BILL ANTIBODY ELUTION
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
7829178
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$112.50 |
| Rate for Payer: Aetna of IA Commercial |
$112.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$112.50
|
| Rate for Payer: Aetna of IA Medicare |
$71.25
|
| Rate for Payer: Amerigroup Medicaid |
$72.10
|
| Rate for Payer: Amerigroup Medicare |
$56.81
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$93.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.40
|
| Rate for Payer: Medical Associates Commercial |
$93.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$87.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.69
|
| Rate for Payer: United Healthcare Commercial |
$112.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$73.75
|
|
|
BILL ANTIBODY ID
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
7829179
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.45 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna of IA Commercial |
$126.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.90
|
| Rate for Payer: Aetna of IA Medicare |
$80.37
|
| Rate for Payer: Amerigroup Medicaid |
$81.33
|
| Rate for Payer: Amerigroup Medicare |
$64.08
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$63.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.54
|
| Rate for Payer: Medical Associates Commercial |
$105.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.45
|
| Rate for Payer: Midlands Choice Commercial |
$98.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$72.97
|
| Rate for Payer: United Healthcare Commercial |
$126.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$83.19
|
|
|
BILL ANTIBODY ID
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
7829179
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$98.70 |
| Max. Negotiated Rate |
$126.90 |
| Rate for Payer: Aetna of IA Commercial |
$126.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.90
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.75
|
| Rate for Payer: Medical Associates Commercial |
$105.75
|
| Rate for Payer: Midlands Choice Commercial |
$98.70
|
| Rate for Payer: United Healthcare Commercial |
$126.90
|
|
|
BILL ANTIBODY SCREEN
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
7862116
|
|
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: 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
|
|
