|
Direct Antiglobulin IgG DMCL
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
8037837
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
Direct Antiglobulin IgG DMCL
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
8037837
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$107.07 |
| 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 |
$29.27
|
| Rate for Payer: Amerigroup Medicare |
$29.29
|
| 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 |
$29.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.99
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO |
$97.34
|
| Rate for Payer: Wellmark IA PPO |
$107.07
|
|
|
Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis With CC
|
Facility
IP
|
$8,573.73
|
|
|
Service Code
|
MS-DRG 442
|
| Hospital Charge Code |
268
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,573.73 |
| Rate for Payer: Amerigroup Medicaid |
$8,532.31
|
| 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 |
$8,449.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,573.73
|
|
|
Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis With MCC
|
Facility
IP
|
$14,515.60
|
|
|
Service Code
|
MS-DRG 441
|
| Hospital Charge Code |
267
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,515.60 |
| Rate for Payer: Amerigroup Medicaid |
$14,445.47
|
| 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 |
$14,305.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,515.60
|
|
|
Disorders of Liver Except Malignancy, Cirrhosis or Alcoholic Hepatitis Without CC/MCC
|
Facility
IP
|
$5,777.49
|
|
|
Service Code
|
MS-DRG 443
|
| Hospital Charge Code |
269
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,777.49 |
| Rate for Payer: Amerigroup Medicaid |
$5,749.58
|
| 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 |
$5,693.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,777.49
|
|
|
Disorders of Pancreas Except Malignancy With CC
|
Facility
IP
|
$7,724.33
|
|
|
Service Code
|
MS-DRG 439
|
| Hospital Charge Code |
265
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,724.33 |
| Rate for Payer: Amerigroup Medicaid |
$7,687.01
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,612.38
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,724.33
|
|
|
Disorders of Pancreas Except Malignancy With MCC
|
Facility
IP
|
$13,372.89
|
|
|
Service Code
|
MS-DRG 438
|
| Hospital Charge Code |
264
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,372.89 |
| Rate for Payer: Amerigroup Medicaid |
$13,308.29
|
| 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 |
$13,179.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,372.89
|
|
|
Disorders of Pancreas Except Malignancy Without CC/MCC
|
Facility
IP
|
$6,594.42
|
|
|
Service Code
|
MS-DRG 440
|
| Hospital Charge Code |
266
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,594.42 |
| Rate for Payer: Amerigroup Medicaid |
$6,562.56
|
| 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 |
$6,498.85
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,594.42
|
|
|
Disorders of Personality and Impulse Control
|
Facility
IP
|
$5,890.68
|
|
|
Service Code
|
MS-DRG 883
|
| Hospital Charge Code |
613
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,890.68 |
| Rate for Payer: Amerigroup Medicaid |
$5,862.22
|
| 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 |
$5,805.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,890.68
|
|
|
Disorders of the Biliary Tract With CC
|
Facility
IP
|
$10,305.01
|
|
|
Service Code
|
MS-DRG 445
|
| Hospital Charge Code |
271
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,305.01 |
| Rate for Payer: Amerigroup Medicaid |
$10,255.23
|
| 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 |
$10,155.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,305.01
|
|
|
Disorders of the Biliary Tract With MCC
|
Facility
IP
|
$11,874.88
|
|
|
Service Code
|
MS-DRG 444
|
| Hospital Charge Code |
270
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,874.88 |
| Rate for Payer: Amerigroup Medicaid |
$11,817.51
|
| 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 |
$11,702.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,874.88
|
|
|
Disorders of the Biliary Tract Without CC/MCC
|
Facility
IP
|
$7,037.33
|
|
|
Service Code
|
MS-DRG 446
|
| Hospital Charge Code |
272
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,037.33 |
| Rate for Payer: Amerigroup Medicaid |
$7,003.33
|
| 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 |
$6,935.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,037.33
|
|
|
DISPOSABLE KIT HIP /BLADES
|
Facility
IP
|
$810.00
|
|
| Hospital Charge Code |
8047066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Aetna of IA Commercial |
$729.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$729.00
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$607.50
|
| Rate for Payer: Medical Associates Commercial |
$607.50
|
| Rate for Payer: Midlands Choice Commercial |
$567.00
|
| Rate for Payer: United Healthcare Commercial |
$729.00
|
|
|
DISPOSABLE KIT HIP /BLADES
|
Facility
OP
|
$810.00
|
|
| Hospital Charge Code |
8047066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.84 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Aetna of IA Commercial |
$729.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$729.00
|
| Rate for Payer: Aetna of IA Medicare |
$461.70
|
| Rate for Payer: Amerigroup Medicaid |
$408.81
|
| Rate for Payer: Amerigroup Medicare |
$409.05
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$607.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$405.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$404.84
|
| Rate for Payer: Medical Associates Commercial |
$607.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$405.00
|
| Rate for Payer: Midlands Choice Commercial |
$567.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$411.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$607.50
|
| Rate for Payer: United Healthcare Commercial |
$729.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$477.90
|
|
|
divalproex sodium 125 mg DR Cap
|
Facility
IP
|
$3.34
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43703125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna of IA Commercial |
$3.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.01
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.50
|
| Rate for Payer: Medical Associates Commercial |
$2.50
|
| Rate for Payer: Midlands Choice Commercial |
$2.34
|
| Rate for Payer: United Healthcare Commercial |
$3.01
|
|
|
divalproex sodium 125 mg DR Cap
|
Facility
OP
|
$3.34
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43703125
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$3.01 |
| Rate for Payer: Aetna of IA Commercial |
$3.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.01
|
| Rate for Payer: Aetna of IA Medicare |
$1.90
|
| Rate for Payer: Amerigroup Medicaid |
$1.69
|
| Rate for Payer: Amerigroup Medicare |
$1.69
|
| Rate for Payer: Cash Price |
$2.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.67
|
| Rate for Payer: Medical Associates Commercial |
$2.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.67
|
| Rate for Payer: Midlands Choice Commercial |
$2.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.50
|
| Rate for Payer: United Healthcare Commercial |
$3.01
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.97
|
|
|
divalproex sodium 250 mg DR Tab
|
Facility
IP
|
$1.38
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Aetna of IA Commercial |
$1.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.24
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.04
|
| Rate for Payer: Medical Associates Commercial |
$1.04
|
| Rate for Payer: Midlands Choice Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
|
|
divalproex sodium 250 mg DR Tab
|
Facility
OP
|
$1.38
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701636
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Aetna of IA Commercial |
$1.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.24
|
| Rate for Payer: Aetna of IA Medicare |
$0.79
|
| Rate for Payer: Amerigroup Medicaid |
$0.70
|
| Rate for Payer: Amerigroup Medicare |
$0.70
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.69
|
| Rate for Payer: Medical Associates Commercial |
$1.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.69
|
| Rate for Payer: Midlands Choice Commercial |
$0.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.81
|
|
|
divalproex sodium 500 mg ER Tab
|
Facility
IP
|
$2.20
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of IA Commercial |
$1.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.98
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.65
|
| Rate for Payer: Medical Associates Commercial |
$1.65
|
| Rate for Payer: Midlands Choice Commercial |
$1.54
|
| Rate for Payer: United Healthcare Commercial |
$1.98
|
|
|
divalproex sodium 500 mg ER Tab
|
Facility
OP
|
$2.20
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700411
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna of IA Commercial |
$1.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.98
|
| Rate for Payer: Aetna of IA Medicare |
$1.25
|
| Rate for Payer: Amerigroup Medicaid |
$1.11
|
| Rate for Payer: Amerigroup Medicare |
$1.11
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.65
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.10
|
| Rate for Payer: Medical Associates Commercial |
$1.65
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.10
|
| Rate for Payer: Midlands Choice Commercial |
$1.54
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.65
|
| Rate for Payer: United Healthcare Commercial |
$1.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.30
|
|
|
DLCO/DIFUSION
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
5338933
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
DLCO/DIFUSION
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
CPT 94729
|
| Hospital Charge Code |
5338933
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$282.35 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$131.22
|
| Rate for Payer: Amerigroup Medicare |
$131.30
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.95
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO |
$256.68
|
| Rate for Payer: Wellmark IA PPO |
$282.35
|
|
|
DNA Double Stranded Antibody DMCL
|
Facility
IP
|
$110.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
8037838
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
DNA Double Stranded Antibody DMCL
|
Facility
OP
|
$110.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
8037838
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$55.52
|
| Rate for Payer: Amerigroup Medicare |
$55.55
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.98
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.00
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$82.50
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
.DNA Double Stranded (dsDNA) Titer by IFA, IgG DMCL
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
8756831
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
