|
hepatitis B adult vaccine 20 mcg/mL Sus[VDMC]
|
Facility
|
IP
|
$108.22
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
13636726
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$97.40 |
| Rate for Payer: Aetna of IA Commercial |
$97.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.40
|
| Rate for Payer: Cash Price |
$86.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.16
|
| Rate for Payer: Medical Associates Commercial |
$81.16
|
| Rate for Payer: Midlands Choice Commercial |
$75.75
|
| Rate for Payer: United Healthcare Commercial |
$97.40
|
|
|
hepatitis B adult vaccine 20 mcg/mL Sus[VDMC]
|
Facility
|
OP
|
$108.22
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
13636726
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$54.09 |
| Max. Negotiated Rate |
$228.47 |
| Rate for Payer: Aetna of IA Commercial |
$97.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.40
|
| Rate for Payer: Aetna of IA Medicare |
$61.69
|
| Rate for Payer: Amerigroup Medicaid |
$54.62
|
| Rate for Payer: Amerigroup Medicare |
$54.65
|
| Rate for Payer: Cash Price |
$86.58
|
| Rate for Payer: Cash Price |
$86.58
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.11
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.09
|
| Rate for Payer: Medical Associates Commercial |
$81.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.11
|
| Rate for Payer: Midlands Choice Commercial |
$75.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.92
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$54.89
|
| Rate for Payer: Oscar Health of IA Commercial |
$81.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.16
|
| Rate for Payer: United Healthcare Commercial |
$97.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.85
|
| Rate for Payer: Wellmark IA HMO |
$207.70
|
| Rate for Payer: Wellmark IA PPO |
$228.47
|
|
|
Hepatitis B Core Antibody IgM DMCL
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
8037860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Aetna of IA Medicare |
$59.85
|
| Rate for Payer: Amerigroup Medicaid |
$52.99
|
| Rate for Payer: Amerigroup Medicare |
$53.02
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.48
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.50
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53.29
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$53.26
|
| Rate for Payer: Oscar Health of IA Commercial |
$78.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.75
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.95
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Hepatitis B Core Antibody IgM DMCL
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
8037860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
|
|
Hepatitis B Core Antibody Total DMCL
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
8037861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
|
|
Hepatitis B Core Antibody Total DMCL
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
8037861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Aetna of IA Commercial |
$88.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.20
|
| Rate for Payer: Aetna of IA Medicare |
$55.86
|
| Rate for Payer: Amerigroup Medicaid |
$49.46
|
| Rate for Payer: Amerigroup Medicare |
$49.49
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.98
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.00
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.74
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$49.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$73.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$73.50
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Hepatitis Be Antibody DMCL
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
8037864
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
|
|
Hepatitis Be Antibody DMCL
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
8037864
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.98 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Aetna of IA Medicare |
$49.02
|
| Rate for Payer: Amerigroup Medicaid |
$43.40
|
| Rate for Payer: Amerigroup Medicare |
$43.43
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$43.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.98
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.00
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$43.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$64.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.50
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.74
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Hepatitis Be Antigen DMCL
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
8037865
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Aetna of IA Medicare |
$49.02
|
| Rate for Payer: Amerigroup Medicaid |
$43.40
|
| Rate for Payer: Amerigroup Medicare |
$43.43
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$43.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.98
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.00
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$43.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$64.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.50
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.74
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Hepatitis Be Antigen DMCL
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
8037865
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
|
|
hepatitis B immune globulin IM Sol 1 mL [VDMC]
|
Facility
|
OP
|
$298.48
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
10393420
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$641.76 |
| Rate for Payer: Aetna of IA Commercial |
$268.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$268.63
|
| Rate for Payer: Aetna of IA Medicare |
$170.13
|
| Rate for Payer: Amerigroup Medicaid |
$150.64
|
| Rate for Payer: Amerigroup Medicare |
$150.73
|
| Rate for Payer: Cash Price |
$238.78
|
| Rate for Payer: Cash Price |
$238.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$223.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$149.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$149.18
|
| Rate for Payer: Medical Associates Commercial |
$223.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$149.24
|
| Rate for Payer: Midlands Choice Commercial |
$208.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$151.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$151.39
|
| Rate for Payer: Oscar Health of IA Commercial |
$223.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$223.86
|
| Rate for Payer: United Healthcare Commercial |
$268.63
|
| Rate for Payer: United Healthcare Managed Medicare |
$176.10
|
| Rate for Payer: Wellmark IA HMO |
$583.42
|
| Rate for Payer: Wellmark IA PPO |
$641.76
|
|
|
hepatitis B immune globulin IM Sol 1 mL [VDMC]
|
Facility
|
IP
|
$298.48
|
|
|
Service Code
|
HCPCS 90371
|
| Hospital Charge Code |
10393420
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$208.94 |
| Max. Negotiated Rate |
$268.63 |
| Rate for Payer: Aetna of IA Commercial |
$268.63
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$268.63
|
| Rate for Payer: Cash Price |
$238.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$223.86
|
| Rate for Payer: Medical Associates Commercial |
$223.86
|
| Rate for Payer: Midlands Choice Commercial |
$208.94
|
| Rate for Payer: United Healthcare Commercial |
$268.63
|
|
|
hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus [VDMC]
|
Facility
|
IP
|
$55.37
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
10393487
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.76 |
| Max. Negotiated Rate |
$49.83 |
| Rate for Payer: Aetna of IA Commercial |
$49.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.83
|
| Rate for Payer: Cash Price |
$44.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.53
|
| Rate for Payer: Medical Associates Commercial |
$41.53
|
| Rate for Payer: Midlands Choice Commercial |
$38.76
|
| Rate for Payer: United Healthcare Commercial |
$49.83
|
|
|
hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus [VDMC]
|
Facility
|
OP
|
$55.37
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
10393487
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$68.20 |
| Rate for Payer: Aetna of IA Commercial |
$49.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.83
|
| Rate for Payer: Aetna of IA Medicare |
$31.56
|
| Rate for Payer: Amerigroup Medicaid |
$27.95
|
| Rate for Payer: Amerigroup Medicare |
$27.96
|
| Rate for Payer: Cash Price |
$44.30
|
| Rate for Payer: Cash Price |
$44.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.53
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.67
|
| Rate for Payer: Medical Associates Commercial |
$41.53
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.68
|
| Rate for Payer: Midlands Choice Commercial |
$38.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.10
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$28.08
|
| Rate for Payer: Oscar Health of IA Commercial |
$41.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.53
|
| Rate for Payer: United Healthcare Commercial |
$49.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.67
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
|
Hepatitis B Surface Antibody DMCL
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
8505640
|
|
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: Molina Healthcare Managed Medicare |
$44.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$66.00
|
| 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
|
|
|
Hepatitis B Surface Antibody DMCL
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
8505640
|
|
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
|
|
|
Hepatitis B Surface Antigen DMCL
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
8037863
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of IA Commercial |
$82.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$82.80
|
| Rate for Payer: Aetna of IA Medicare |
$52.44
|
| Rate for Payer: Amerigroup Medicaid |
$46.43
|
| Rate for Payer: Amerigroup Medicare |
$46.46
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$46.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$45.98
|
| Rate for Payer: Medical Associates Commercial |
$69.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.00
|
| Rate for Payer: Midlands Choice Commercial |
$64.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46.69
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$46.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$69.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.00
|
| Rate for Payer: United Healthcare Commercial |
$82.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$54.28
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Hepatitis B Surface Antigen DMCL
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
8037863
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of IA Commercial |
$82.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$82.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.00
|
| Rate for Payer: Medical Associates Commercial |
$69.00
|
| Rate for Payer: Midlands Choice Commercial |
$64.40
|
| Rate for Payer: United Healthcare Commercial |
$82.80
|
|
|
Hepatitis C Antibody Screen DMCL
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
8037866
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
|
|
Hepatitis C Antibody Screen DMCL
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
8037866
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Aetna of IA Medicare |
$66.69
|
| Rate for Payer: Amerigroup Medicaid |
$59.05
|
| Rate for Payer: Amerigroup Medicare |
$59.08
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.48
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.38
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$59.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$87.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.03
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Hepatitis C RNA and Quant (R-PCR) DMCL
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
8037867
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna of IA Commercial |
$367.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$367.20
|
| Rate for Payer: Aetna of IA Medicare |
$232.56
|
| Rate for Payer: Amerigroup Medicaid |
$205.92
|
| Rate for Payer: Amerigroup Medicare |
$206.04
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$306.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$204.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$203.92
|
| Rate for Payer: Medical Associates Commercial |
$306.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$204.00
|
| Rate for Payer: Midlands Choice Commercial |
$285.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$207.06
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$206.94
|
| Rate for Payer: Oscar Health of IA Commercial |
$306.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$306.00
|
| Rate for Payer: United Healthcare Commercial |
$367.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$240.72
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
Hepatitis C RNA and Quant (R-PCR) DMCL
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
8037867
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna of IA Commercial |
$367.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$367.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$306.00
|
| Rate for Payer: Medical Associates Commercial |
$306.00
|
| Rate for Payer: Midlands Choice Commercial |
$285.60
|
| Rate for Payer: United Healthcare Commercial |
$367.20
|
|
|
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
|
|
|
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: Molina Healthcare Managed Medicare |
$71.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$105.00
|
| 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
|
|
|
Hepatobiliary Diagnostic Procedures With CC
|
Facility
|
IP
|
$18,793.11
|
|
|
Service Code
|
MS-DRG 421
|
| Hospital Charge Code |
253
|
| Min. Negotiated Rate |
$18,520.74 |
| Max. Negotiated Rate |
$18,793.11 |
| Rate for Payer: Amerigroup Medicaid |
$18,702.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18,520.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,793.11
|
|
