|
Hemoglobin A1c DMCL
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
8037857
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.49 |
| 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 |
$44.41
|
| Rate for Payer: Amerigroup Medicare |
$35.00
|
| 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 |
$34.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.98
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.65
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.85
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
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/EXTERNAL 2 OR MORE
|
Professional
|
Both
|
$1,663.00
|
|
|
Service Code
|
CPT 46260
|
| Hospital Charge Code |
8825543
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$460.64 |
| Max. Negotiated Rate |
$1,247.25 |
| Rate for Payer: Amerigroup Medicaid |
$465.16
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$460.64
|
| Rate for Payer: Medical Associates Commercial |
$1,247.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,164.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$462.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,247.25
|
| Rate for Payer: United Healthcare Commercial |
$726.86
|
| Rate for Payer: Wellmark IA HMO WHPI |
$933.20
|
| Rate for Payer: Wellmark IA PPO |
$1,097.80
|
|
|
heparin 25,000 units-NaCl 0.45% Sol 250ml bag [VDMC]
|
Facility
|
OP
|
$87.85
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
16879209
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.53 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$79.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.06
|
| Rate for Payer: Aetna of IA Medicare |
$50.07
|
| Rate for Payer: Amerigroup Medicaid |
$50.67
|
| Rate for Payer: Amerigroup Medicare |
$39.93
|
| Rate for Payer: Cash Price |
$70.28
|
| Rate for Payer: Cash Price |
$70.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$65.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$39.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.18
|
| Rate for Payer: Medical Associates Commercial |
$65.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.53
|
| Rate for Payer: Midlands Choice Commercial |
$61.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.46
|
| Rate for Payer: United Healthcare Commercial |
$79.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.83
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
heparin 25,000 units-NaCl 0.45% Sol 250ml bag [VDMC]
|
Facility
|
IP
|
$87.85
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
16879209
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$61.50 |
| Max. Negotiated Rate |
$79.06 |
| Rate for Payer: Aetna of IA Commercial |
$79.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.06
|
| Rate for Payer: Cash Price |
$70.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$65.89
|
| Rate for Payer: Medical Associates Commercial |
$65.89
|
| Rate for Payer: Midlands Choice Commercial |
$61.50
|
| Rate for Payer: United Healthcare Commercial |
$79.06
|
|
|
heparin 5000 units/mL 1 ml SDS Inj [VDMC]
|
Facility
|
IP
|
$23.42
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10393209
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.40 |
| 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 |
$17.57
|
| Rate for Payer: Medical Associates Commercial |
$17.57
|
| Rate for Payer: Midlands Choice Commercial |
$16.40
|
| Rate for Payer: United Healthcare Commercial |
$21.08
|
|
|
heparin 5000 units/mL 1 ml SDS Inj [VDMC]
|
Facility
|
OP
|
$23.42
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
10393209
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$13.51
|
| Rate for Payer: Amerigroup Medicare |
$10.65
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.57
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.38
|
| Rate for Payer: Medical Associates Commercial |
$17.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.54
|
| Rate for Payer: Midlands Choice Commercial |
$16.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.12
|
| Rate for Payer: United Healthcare Commercial |
$21.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.82
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
heparin flush ADULT 100 units/mL 5 ML SDS Sol [VDMC]
|
Facility
|
OP
|
$21.69
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
10393349
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.76 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$19.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.52
|
| Rate for Payer: Aetna of IA Medicare |
$12.37
|
| Rate for Payer: Amerigroup Medicaid |
$12.51
|
| Rate for Payer: Amerigroup Medicare |
$9.86
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.27
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.39
|
| Rate for Payer: Medical Associates Commercial |
$16.27
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.76
|
| Rate for Payer: Midlands Choice Commercial |
$15.19
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.23
|
| Rate for Payer: United Healthcare Commercial |
$19.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.80
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
heparin flush ADULT 100 units/mL 5 ML SDS Sol [VDMC]
|
Facility
|
IP
|
$21.69
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
10393349
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$19.52 |
| Rate for Payer: Aetna of IA Commercial |
$19.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$19.52
|
| Rate for Payer: Cash Price |
$17.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.27
|
| Rate for Payer: Medical Associates Commercial |
$16.27
|
| Rate for Payer: Midlands Choice Commercial |
$15.19
|
| Rate for Payer: United Healthcare Commercial |
$19.52
|
|
|
heparin flush BABY 10 units/mL 3 MLSol [VDMC]
|
Facility
|
OP
|
$21.27
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
10393278
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$12.27
|
| Rate for Payer: Amerigroup Medicare |
$9.67
|
| Rate for Payer: Cash Price |
$17.01
|
| 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 |
$9.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.15
|
| Rate for Payer: Medical Associates Commercial |
$15.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.57
|
| Rate for Payer: Midlands Choice Commercial |
$14.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.01
|
| Rate for Payer: United Healthcare Commercial |
$19.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.55
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
heparin flush BABY 10 units/mL 3 MLSol [VDMC]
|
Facility
|
IP
|
$21.27
|
|
|
Service Code
|
HCPCS J1642
|
| Hospital Charge Code |
10393278
|
|
Hospital Revenue Code
|
259
|
| 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[VDMC]
|
Facility
|
IP
|
$146.41
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
12945366
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$102.49 |
| Max. Negotiated Rate |
$131.77 |
| Rate for Payer: Aetna of IA Commercial |
$131.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.77
|
| Rate for Payer: Cash Price |
$117.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.81
|
| Rate for Payer: Medical Associates Commercial |
$109.81
|
| Rate for Payer: Midlands Choice Commercial |
$102.49
|
| Rate for Payer: United Healthcare Commercial |
$131.77
|
|
|
hepatitis A adult vaccine 1440 units/mL preservative free Sus[VDMC]
|
Facility
|
OP
|
$146.41
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
12945366
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$65.89 |
| Max. Negotiated Rate |
$131.77 |
| Rate for Payer: Aetna of IA Commercial |
$131.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.77
|
| Rate for Payer: Aetna of IA Medicare |
$83.46
|
| Rate for Payer: Amerigroup Medicaid |
$84.45
|
| Rate for Payer: Amerigroup Medicare |
$66.55
|
| Rate for Payer: Cash Price |
$117.13
|
| Rate for Payer: Cash Price |
$117.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.81
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$65.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$83.63
|
| Rate for Payer: Medical Associates Commercial |
$109.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.89
|
| Rate for Payer: Midlands Choice Commercial |
$102.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$84.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.77
|
| Rate for Payer: United Healthcare Commercial |
$131.77
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$80.12
|
| Rate for Payer: Wellmark IA PPO |
$88.25
|
|
|
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 IgM DMCL
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
8037858
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$61.72
|
| Rate for Payer: Amerigroup Medicare |
$48.63
|
| 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 |
$48.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.12
|
| Rate for Payer: Medical Associates Commercial |
$80.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.15
|
| Rate for Payer: Midlands Choice Commercial |
$74.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.37
|
| Rate for Payer: United Healthcare Commercial |
$96.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.13
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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 Antibody Total DMCL
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
8037859
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$68.06
|
| Rate for Payer: Amerigroup Medicare |
$53.63
|
| 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 |
$53.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.40
|
| Rate for Payer: Medical Associates Commercial |
$88.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.10
|
| Rate for Payer: Midlands Choice Commercial |
$82.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.06
|
| Rate for Payer: United Healthcare Commercial |
$106.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.62
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
hepatitis A pediatric vaccine 25 units/0.5 mL SDV [VDMC]
|
Facility
|
OP
|
$73.58
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
18590050
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$88.25 |
| 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 |
$42.44
|
| Rate for Payer: Amerigroup Medicare |
$33.44
|
| 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 |
$33.11
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.03
|
| Rate for Payer: Medical Associates Commercial |
$55.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.11
|
| Rate for Payer: Midlands Choice Commercial |
$51.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.08
|
| Rate for Payer: United Healthcare Commercial |
$66.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$80.12
|
| Rate for Payer: Wellmark IA PPO |
$88.25
|
|
|
hepatitis A pediatric vaccine 25 units/0.5 mL SDV [VDMC]
|
Facility
|
IP
|
$73.58
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
18590050
|
|
Hospital Revenue Code
|
259
|
| 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 720 units/0.5 mL preservative free Sus[VDMC]
|
Facility
|
OP
|
$72.38
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
15904355
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.57 |
| Max. Negotiated Rate |
$88.25 |
| 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 |
$41.75
|
| Rate for Payer: Amerigroup Medicare |
$32.90
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.29
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.34
|
| Rate for Payer: Medical Associates Commercial |
$54.29
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.57
|
| Rate for Payer: Midlands Choice Commercial |
$50.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.46
|
| Rate for Payer: United Healthcare Commercial |
$65.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.71
|
| Rate for Payer: Wellmark IA HMO WHPI |
$80.12
|
| Rate for Payer: Wellmark IA PPO |
$88.25
|
|
|
hepatitis A pediatric vaccine 720 units/0.5 mL preservative free Sus[VDMC]
|
Facility
|
IP
|
$72.38
|
|
|
Service Code
|
HCPCS 90633
|
| Hospital Charge Code |
15904355
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$65.14 |
| Rate for Payer: Aetna of IA Commercial |
$65.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$65.14
|
| Rate for Payer: Cash Price |
$57.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.29
|
| Rate for Payer: Medical Associates Commercial |
$54.29
|
| Rate for Payer: Midlands Choice Commercial |
$50.67
|
| Rate for Payer: United Healthcare Commercial |
$65.14
|
|
|
hepatitis B adult vaccine 10 mcg/mL Sus[VDMC]
|
Facility
|
OP
|
$102.38
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
11815338
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.07 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna of IA Commercial |
$92.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.14
|
| Rate for Payer: Aetna of IA Medicare |
$58.36
|
| Rate for Payer: Amerigroup Medicaid |
$59.05
|
| Rate for Payer: Amerigroup Medicare |
$46.53
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$76.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$46.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.48
|
| Rate for Payer: Medical Associates Commercial |
$76.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.07
|
| Rate for Payer: Midlands Choice Commercial |
$71.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.98
|
| Rate for Payer: United Healthcare Commercial |
$92.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$80.12
|
| Rate for Payer: Wellmark IA PPO |
$88.25
|
|
|
hepatitis B adult vaccine 10 mcg/mL Sus[VDMC]
|
Facility
|
IP
|
$102.38
|
|
|
Service Code
|
HCPCS 90746
|
| Hospital Charge Code |
11815338
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$71.67 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna of IA Commercial |
$92.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.14
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$76.78
|
| Rate for Payer: Medical Associates Commercial |
$76.78
|
| Rate for Payer: Midlands Choice Commercial |
$71.67
|
| Rate for Payer: United Healthcare Commercial |
$92.14
|
|
|
hepatitis B adult vaccine 20 mcg/mL Sus[VDMC]
|
Facility
|
OP
|
$104.43
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
13636726
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$400.65 |
| Rate for Payer: Aetna of IA Commercial |
$93.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.99
|
| Rate for Payer: Aetna of IA Medicare |
$59.53
|
| Rate for Payer: Amerigroup Medicaid |
$60.24
|
| Rate for Payer: Amerigroup Medicare |
$47.46
|
| Rate for Payer: Cash Price |
$83.54
|
| Rate for Payer: Cash Price |
$83.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$46.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.65
|
| Rate for Payer: Medical Associates Commercial |
$78.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$46.99
|
| Rate for Payer: Midlands Choice Commercial |
$73.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.04
|
| Rate for Payer: United Healthcare Commercial |
$93.99
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.61
|
| Rate for Payer: Wellmark IA HMO WHPI |
$363.72
|
| Rate for Payer: Wellmark IA PPO |
$400.65
|
|
|
hepatitis B adult vaccine 20 mcg/mL Sus[VDMC]
|
Facility
|
IP
|
$104.43
|
|
|
Service Code
|
HCPCS 90740
|
| Hospital Charge Code |
13636726
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$93.99 |
| Rate for Payer: Aetna of IA Commercial |
$93.99
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.99
|
| Rate for Payer: Cash Price |
$83.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.32
|
| Rate for Payer: Medical Associates Commercial |
$78.32
|
| Rate for Payer: Midlands Choice Commercial |
$73.10
|
| Rate for Payer: United Healthcare Commercial |
$93.99
|
|
