|
Hepatitis D Virus Delta Antibody DMCL
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
8037868
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| 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 |
$70.66
|
| Rate for Payer: Amerigroup Medicare |
$70.70
|
| 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 |
$70.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.97
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.60
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Hepatitis D Virus Delta Antibody DMCL
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
8037868
|
|
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
|
|
|
Hepatobiliary Diagnostic Procedures With CC
|
Facility
IP
|
$18,793.11
|
|
|
Service Code
|
MS-DRG 421
|
| Hospital Charge Code |
253
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$18,793.11 |
| Rate for Payer: Amerigroup Medicaid |
$18,702.32
|
| 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 |
$18,520.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,793.11
|
|
|
Hepatobiliary Diagnostic Procedures With MCC
|
Facility
IP
|
$34,596.09
|
|
|
Service Code
|
MS-DRG 420
|
| Hospital Charge Code |
252
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$34,596.09 |
| Rate for Payer: Amerigroup Medicaid |
$34,428.96
|
| 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 |
$34,094.69
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34,596.09
|
|
|
Hepatobiliary Diagnostic Procedures Without CC/MCC
|
Facility
IP
|
$10,157.38
|
|
|
Service Code
|
MS-DRG 422
|
| Hospital Charge Code |
254
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,157.38 |
| Rate for Payer: Amerigroup Medicaid |
$10,108.31
|
| 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 |
$10,010.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,157.38
|
|
|
Hep B Sur Ab Quant DMCL
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
8037862
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.98 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of IA Commercial |
$79.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.20
|
| Rate for Payer: Aetna of IA Medicare |
$50.16
|
| Rate for Payer: Amerigroup Medicaid |
$44.41
|
| Rate for Payer: Amerigroup Medicare |
$44.44
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.98
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.00
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.92
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Hep B Sur Ab Quant DMCL
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
8037862
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of IA Commercial |
$79.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.20
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.00
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
|
|
Hernia Procedures Except Inguinal and Femoral With CC
|
Facility
IP
|
$14,908.31
|
|
|
Service Code
|
MS-DRG 354
|
| Hospital Charge Code |
204
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,908.31 |
| Rate for Payer: Amerigroup Medicaid |
$14,836.28
|
| 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 |
$14,692.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,908.31
|
|
|
Hernia Procedures Except Inguinal and Femoral With MCC
|
Facility
IP
|
$19,824.60
|
|
|
Service Code
|
MS-DRG 353
|
| Hospital Charge Code |
203
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$19,824.60 |
| Rate for Payer: Amerigroup Medicaid |
$19,728.83
|
| 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 |
$19,537.28
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,824.60
|
|
|
Hernia Procedures Except Inguinal and Femoral Without CC/MCC
|
Facility
IP
|
$13,281.36
|
|
|
Service Code
|
MS-DRG 355
|
| Hospital Charge Code |
205
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,281.36 |
| Rate for Payer: Amerigroup Medicaid |
$13,217.20
|
| 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 |
$13,088.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,281.36
|
|
|
Herpes Simplex PCR Qual DMCL
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037869
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
Herpes Simplex PCR Qual DMCL
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037869
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
Herpes Simplex PCR Qual Stat DMCL
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037870
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
Herpes Simplex PCR Qual Stat DMCL
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037870
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
Herpes Simplex Virus by PCR DMCL
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037872
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
Herpes Simplex Virus by PCR DMCL
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037872
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
Herpes Simplex Virus IgM Antibody DMCL
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
8037873
|
|
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
|
|
|
Herpes Simplex Virus IgM Antibody DMCL
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
8037873
|
|
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
|
|
|
HERPES SIMPLEX VIRUS PCR
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8093935
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
HERPES SIMPLEX VIRUS PCR
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8093935
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
hetastarch
|
Facility
IP
|
$50.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43707975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of IA Commercial |
$45.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.50
|
| Rate for Payer: Medical Associates Commercial |
$37.50
|
| Rate for Payer: Midlands Choice Commercial |
$35.00
|
| Rate for Payer: United Healthcare Commercial |
$45.00
|
|
|
hetastarch
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43707975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna of IA Commercial |
$45.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.00
|
| Rate for Payer: Aetna of IA Medicare |
$28.50
|
| Rate for Payer: Amerigroup Medicaid |
$25.24
|
| Rate for Payer: Amerigroup Medicare |
$25.25
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.99
|
| Rate for Payer: Medical Associates Commercial |
$37.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.00
|
| Rate for Payer: Midlands Choice Commercial |
$35.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.50
|
| Rate for Payer: United Healthcare Commercial |
$45.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$29.50
|
|
|
hetastarch 60 mg/mL-NS IV Sol
|
Facility
OP
|
$107.64
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43707975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$96.88 |
| Rate for Payer: Aetna of IA Commercial |
$96.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.88
|
| Rate for Payer: Aetna of IA Medicare |
$61.35
|
| Rate for Payer: Amerigroup Medicaid |
$54.33
|
| Rate for Payer: Amerigroup Medicare |
$54.36
|
| Rate for Payer: Cash Price |
$86.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$53.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.80
|
| Rate for Payer: Medical Associates Commercial |
$80.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.82
|
| Rate for Payer: Midlands Choice Commercial |
$75.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.73
|
| Rate for Payer: United Healthcare Commercial |
$96.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.51
|
|
|
hetastarch 60 mg/mL-NS IV Sol
|
Facility
IP
|
$107.64
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43707975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.35 |
| Max. Negotiated Rate |
$96.88 |
| Rate for Payer: Aetna of IA Commercial |
$96.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.88
|
| Rate for Payer: Cash Price |
$86.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.73
|
| Rate for Payer: Medical Associates Commercial |
$80.73
|
| Rate for Payer: Midlands Choice Commercial |
$75.35
|
| Rate for Payer: United Healthcare Commercial |
$96.88
|
|
|
Hgb A1C
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
1383763
|
|
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
|
|
