|
Hemoglobin
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
1635635
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
|
|
Hemoglobin
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
1635635
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Aetna of IA Medicare |
$19.95
|
| Rate for Payer: Amerigroup Medicaid |
$17.66
|
| Rate for Payer: Amerigroup Medicare |
$17.68
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.49
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.50
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.25
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.65
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
HEMOGLOBIN
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Aetna of IA Medicare |
$19.95
|
| Rate for Payer: Amerigroup Medicaid |
$17.66
|
| Rate for Payer: Amerigroup Medicare |
$17.68
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.49
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.50
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.25
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.65
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
HEMOGLOBIN
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
|
|
Hemoglobin A1c DMCL
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
8037857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Aetna of IA Medicare |
$43.89
|
| Rate for Payer: Amerigroup Medicaid |
$38.86
|
| Rate for Payer: Amerigroup Medicare |
$38.88
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.48
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.50
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.75
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Hemoglobin A1c DMCL
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
8037857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
|
|
Hemorrhoidectomy, internal, by rubber band ligation(s)
|
Facility
OP
|
$1,451.30
|
|
|
Service Code
|
CPT 46221
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,319.36 |
| Max. Negotiated Rate |
$1,451.30 |
| Rate for Payer: Wellmark IA HMO |
$1,319.36
|
| Rate for Payer: Wellmark IA PPO |
$1,451.30
|
|
|
HEMORRHOIDECTOMY INTERNAL/EXTERNAL 2 OR MORE
|
Professional
|
$1,663.00
|
|
|
Service Code
|
CPT 46260
|
| Hospital Charge Code |
8825543
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$434.59 |
| Max. Negotiated Rate |
$1,164.10 |
| Rate for Payer: Aetna of IA Medicare |
$434.59
|
| Rate for Payer: Amerigroup Medicaid |
$449.37
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$521.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$443.28
|
| Rate for Payer: Medical Associates Commercial |
$825.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$434.59
|
| Rate for Payer: Midlands Choice Commercial |
$1,164.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$651.88
|
| Rate for Payer: Wellmark IA HMO |
$923.00
|
| Rate for Payer: Wellmark IA PPO |
$1,083.00
|
|
|
heparin 25,000 units-NaCl 0.45% Sol 250ml bag
|
Facility
IP
|
$86.06
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
43700253
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.24 |
| Max. Negotiated Rate |
$77.45 |
| Rate for Payer: Aetna of IA Commercial |
$77.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.45
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.54
|
| Rate for Payer: Medical Associates Commercial |
$64.54
|
| Rate for Payer: Midlands Choice Commercial |
$60.24
|
| Rate for Payer: United Healthcare Commercial |
$77.45
|
|
|
heparin 25,000 units-NaCl 0.45% Sol 250ml bag
|
Facility
OP
|
$86.06
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
43700253
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.01 |
| Max. Negotiated Rate |
$77.45 |
| Rate for Payer: Aetna of IA Commercial |
$77.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.45
|
| Rate for Payer: Aetna of IA Medicare |
$49.05
|
| Rate for Payer: Amerigroup Medicaid |
$43.43
|
| Rate for Payer: Amerigroup Medicare |
$43.46
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$43.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.01
|
| Rate for Payer: Medical Associates Commercial |
$64.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.03
|
| Rate for Payer: Midlands Choice Commercial |
$60.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.54
|
| Rate for Payer: United Healthcare Commercial |
$77.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.78
|
|
|
heparin 5000 units/mL 1 ml SDS Inj
|
Facility
IP
|
$23.42
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
43701128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$21.08 |
| Rate for Payer: Aetna of IA Commercial |
$21.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.08
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.56
|
| Rate for Payer: Medical Associates Commercial |
$17.56
|
| Rate for Payer: Midlands Choice Commercial |
$16.39
|
| Rate for Payer: United Healthcare Commercial |
$21.08
|
|
|
heparin 5000 units/mL 1 ml SDS Inj
|
Facility
OP
|
$23.42
|
|
|
Service Code
|
CPT J1644
|
| Hospital Charge Code |
43701128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$21.08 |
| Rate for Payer: Aetna of IA Commercial |
$21.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.08
|
| Rate for Payer: Aetna of IA Medicare |
$13.35
|
| Rate for Payer: Amerigroup Medicaid |
$11.82
|
| Rate for Payer: Amerigroup Medicare |
$11.83
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.71
|
| Rate for Payer: Medical Associates Commercial |
$17.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.71
|
| Rate for Payer: Midlands Choice Commercial |
$16.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.56
|
| Rate for Payer: United Healthcare Commercial |
$21.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.82
|
|
|
heparin flush ADULT 100 units/mL 5 ML SDS Sol
|
Facility
OP
|
$21.29
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
43700034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna of IA Commercial |
$19.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.16
|
| Rate for Payer: Aetna of IA Medicare |
$12.14
|
| Rate for Payer: Amerigroup Medicaid |
$10.75
|
| Rate for Payer: Amerigroup Medicare |
$10.75
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.64
|
| Rate for Payer: Medical Associates Commercial |
$15.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.64
|
| Rate for Payer: Midlands Choice Commercial |
$14.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.97
|
| Rate for Payer: United Healthcare Commercial |
$19.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.56
|
|
|
heparin flush ADULT 100 units/mL 5 ML SDS Sol
|
Facility
IP
|
$21.29
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
43700034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna of IA Commercial |
$19.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.16
|
| Rate for Payer: Cash Price |
$17.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.97
|
| Rate for Payer: Medical Associates Commercial |
$15.97
|
| Rate for Payer: Midlands Choice Commercial |
$14.90
|
| Rate for Payer: United Healthcare Commercial |
$19.16
|
|
|
heparin flush BABY 10 units/mL 3 MLSol
|
Facility
OP
|
$21.27
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
43700035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna of IA Commercial |
$19.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.14
|
| Rate for Payer: Aetna of IA Medicare |
$12.12
|
| Rate for Payer: Amerigroup Medicaid |
$10.73
|
| Rate for Payer: Amerigroup Medicare |
$10.74
|
| Rate for Payer: Cash Price |
$17.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.63
|
| Rate for Payer: Medical Associates Commercial |
$15.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.64
|
| Rate for Payer: Midlands Choice Commercial |
$14.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.95
|
| Rate for Payer: United Healthcare Commercial |
$19.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.55
|
|
|
heparin flush BABY 10 units/mL 3 MLSol
|
Facility
IP
|
$21.27
|
|
|
Service Code
|
CPT J1642
|
| Hospital Charge Code |
43700035
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$19.14 |
| Rate for Payer: Aetna of IA Commercial |
$19.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.14
|
| Rate for Payer: Cash Price |
$17.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.95
|
| Rate for Payer: Medical Associates Commercial |
$15.95
|
| Rate for Payer: Midlands Choice Commercial |
$14.89
|
| Rate for Payer: United Healthcare Commercial |
$19.14
|
|
|
hepatitis A adult vaccine 1440 units/mL preservative free Sus
|
Facility
IP
|
$147.42
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
43700489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.19 |
| Max. Negotiated Rate |
$132.68 |
| Rate for Payer: Aetna of IA Commercial |
$132.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.68
|
| Rate for Payer: Cash Price |
$117.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.56
|
| Rate for Payer: Medical Associates Commercial |
$110.56
|
| Rate for Payer: Midlands Choice Commercial |
$103.19
|
| Rate for Payer: United Healthcare Commercial |
$132.68
|
|
|
hepatitis A adult vaccine 1440 units/mL preservative free Sus
|
Facility
OP
|
$147.42
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
43700489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$132.68 |
| Rate for Payer: Aetna of IA Commercial |
$132.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.68
|
| Rate for Payer: Aetna of IA Medicare |
$84.03
|
| Rate for Payer: Amerigroup Medicaid |
$74.40
|
| Rate for Payer: Amerigroup Medicare |
$74.45
|
| Rate for Payer: Cash Price |
$117.94
|
| Rate for Payer: Cash Price |
$117.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.68
|
| Rate for Payer: Medical Associates Commercial |
$110.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.71
|
| Rate for Payer: Midlands Choice Commercial |
$103.19
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$110.56
|
| Rate for Payer: United Healthcare Commercial |
$132.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.98
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
|
Hepatitis A Antibody IgM DMCL
|
Facility
OP
|
$107.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
8037858
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Aetna of IA Commercial |
$96.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.30
|
| Rate for Payer: Aetna of IA Medicare |
$60.99
|
| Rate for Payer: Amerigroup Medicaid |
$54.00
|
| Rate for Payer: Amerigroup Medicare |
$54.04
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$53.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.48
|
| Rate for Payer: Medical Associates Commercial |
$80.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.50
|
| Rate for Payer: Midlands Choice Commercial |
$74.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.25
|
| Rate for Payer: United Healthcare Commercial |
$96.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.13
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Hepatitis A Antibody IgM DMCL
|
Facility
IP
|
$107.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
8037858
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$74.90 |
| Max. Negotiated Rate |
$96.30 |
| Rate for Payer: Aetna of IA Commercial |
$96.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.30
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.25
|
| Rate for Payer: Medical Associates Commercial |
$80.25
|
| Rate for Payer: Midlands Choice Commercial |
$74.90
|
| Rate for Payer: United Healthcare Commercial |
$96.30
|
|
|
Hepatitis A Antibody Total DMCL
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
8037859
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna of IA Commercial |
$106.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.20
|
| Rate for Payer: Aetna of IA Medicare |
$67.26
|
| Rate for Payer: Amerigroup Medicaid |
$59.55
|
| Rate for Payer: Amerigroup Medicare |
$59.59
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.98
|
| Rate for Payer: Medical Associates Commercial |
$88.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.00
|
| Rate for Payer: Midlands Choice Commercial |
$82.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$88.50
|
| Rate for Payer: United Healthcare Commercial |
$106.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.62
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Hepatitis A Antibody Total DMCL
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
8037859
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna of IA Commercial |
$106.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.20
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.50
|
| Rate for Payer: Medical Associates Commercial |
$88.50
|
| Rate for Payer: Midlands Choice Commercial |
$82.60
|
| Rate for Payer: United Healthcare Commercial |
$106.20
|
|
|
hepatitis A pediatric vaccine 25 units/0.5 mL SDV
|
Facility
IP
|
$73.58
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
43700402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.51 |
| Max. Negotiated Rate |
$66.22 |
| Rate for Payer: Aetna of IA Commercial |
$66.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.22
|
| Rate for Payer: Cash Price |
$58.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.18
|
| Rate for Payer: Medical Associates Commercial |
$55.18
|
| Rate for Payer: Midlands Choice Commercial |
$51.51
|
| Rate for Payer: United Healthcare Commercial |
$66.22
|
|
|
hepatitis A pediatric vaccine 25 units/0.5 mL SDV
|
Facility
OP
|
$73.58
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
43700402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.78 |
| Max. Negotiated Rate |
$68.20 |
| Rate for Payer: Aetna of IA Commercial |
$66.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.22
|
| Rate for Payer: Aetna of IA Medicare |
$41.94
|
| Rate for Payer: Amerigroup Medicaid |
$37.14
|
| Rate for Payer: Amerigroup Medicare |
$37.16
|
| Rate for Payer: Cash Price |
$58.86
|
| Rate for Payer: Cash Price |
$58.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.78
|
| Rate for Payer: Medical Associates Commercial |
$55.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.79
|
| Rate for Payer: Midlands Choice Commercial |
$51.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.18
|
| Rate for Payer: United Healthcare Commercial |
$66.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.41
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
|
hepatitis A pediatric vaccine 720 units/0.5 mL preservative free Sus
|
Facility
OP
|
$72.38
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
43700443
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.18 |
| Max. Negotiated Rate |
$68.20 |
| Rate for Payer: Aetna of IA Commercial |
$65.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.14
|
| Rate for Payer: Aetna of IA Medicare |
$41.26
|
| Rate for Payer: Amerigroup Medicaid |
$36.53
|
| Rate for Payer: Amerigroup Medicare |
$36.55
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.18
|
| Rate for Payer: Medical Associates Commercial |
$54.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.19
|
| Rate for Payer: Midlands Choice Commercial |
$50.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.28
|
| Rate for Payer: United Healthcare Commercial |
$65.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.70
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
