|
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 IgM DMCL
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
8037860
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$60.56
|
| Rate for Payer: Amerigroup Medicare |
$47.72
|
| 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 |
$47.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.98
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.25
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.34
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.95
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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 |
$41.83 |
| 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 |
$56.53
|
| Rate for Payer: Amerigroup Medicare |
$44.54
|
| 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 |
$44.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.98
|
| Rate for Payer: Medical Associates Commercial |
$73.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.10
|
| Rate for Payer: Midlands Choice Commercial |
$68.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$50.72
|
| Rate for Payer: United Healthcare Commercial |
$88.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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 Be Antibody DMCL
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
8037864
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$38.70 |
| 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 |
$49.60
|
| Rate for Payer: Amerigroup Medicare |
$39.09
|
| 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 |
$38.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.12
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.70
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.50
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.74
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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 Antigen DMCL
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
8037865
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.03 |
| 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 |
$49.60
|
| Rate for Payer: Amerigroup Medicare |
$39.09
|
| 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 |
$38.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.12
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.70
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.50
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.74
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
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
|
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 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 |
$134.32 |
| 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: Aetna of IA Medicare |
$170.13
|
| Rate for Payer: Amerigroup Medicaid |
$172.16
|
| Rate for Payer: Amerigroup Medicare |
$135.66
|
| 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 |
$134.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$170.49
|
| Rate for Payer: Medical Associates Commercial |
$223.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$134.32
|
| Rate for Payer: Midlands Choice Commercial |
$208.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$173.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$154.46
|
| Rate for Payer: United Healthcare Commercial |
$268.63
|
| Rate for Payer: United Healthcare Managed Medicare |
$176.10
|
|
|
hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus [VDMC]
|
Facility
|
OP
|
$57.72
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
10393487
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$88.25 |
| Rate for Payer: Aetna of IA Commercial |
$51.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.95
|
| Rate for Payer: Aetna of IA Medicare |
$32.90
|
| Rate for Payer: Amerigroup Medicaid |
$33.29
|
| Rate for Payer: Amerigroup Medicare |
$26.23
|
| Rate for Payer: Cash Price |
$46.18
|
| Rate for Payer: Cash Price |
$46.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.29
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.97
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.97
|
| Rate for Payer: Medical Associates Commercial |
$43.29
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.97
|
| Rate for Payer: Midlands Choice Commercial |
$40.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$29.87
|
| Rate for Payer: United Healthcare Commercial |
$51.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.05
|
| Rate for Payer: Wellmark IA HMO WHPI |
$80.12
|
| Rate for Payer: Wellmark IA PPO |
$88.25
|
|
|
hepatitis B pediatric vaccine 10 mcg/0.5 mL Sus [VDMC]
|
Facility
|
IP
|
$57.72
|
|
|
Service Code
|
HCPCS 90744
|
| Hospital Charge Code |
10393487
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$51.95 |
| Rate for Payer: Aetna of IA Commercial |
$51.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.95
|
| Rate for Payer: Cash Price |
$46.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.29
|
| Rate for Payer: Medical Associates Commercial |
$43.29
|
| Rate for Payer: Midlands Choice Commercial |
$40.40
|
| Rate for Payer: United Healthcare Commercial |
$51.95
|
|
|
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 Antibody DMCL
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
8505640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$39.60 |
| 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: Aetna of IA Medicare |
$50.16
|
| Rate for Payer: Amerigroup Medicaid |
$50.76
|
| Rate for Payer: Amerigroup Medicare |
$40.00
|
| 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 |
$39.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.27
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.60
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.54
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.92
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
Hepatitis B Surface Antigen DMCL
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
8037863
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.03 |
| 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 |
$53.07
|
| Rate for Payer: Amerigroup Medicare |
$41.81
|
| 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 |
$41.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.55
|
| Rate for Payer: Medical Associates Commercial |
$69.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.40
|
| Rate for Payer: Midlands Choice Commercial |
$64.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.61
|
| Rate for Payer: United Healthcare Commercial |
$82.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$54.28
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
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
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
8037866
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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 |
$67.49
|
| Rate for Payer: Amerigroup Medicare |
$53.18
|
| 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 |
$52.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$66.83
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.65
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$67.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.55
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.03
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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 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 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 |
$86.50 |
| 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 |
$235.33
|
| Rate for Payer: Amerigroup Medicare |
$185.44
|
| 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 |
$183.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$233.05
|
| Rate for Payer: Medical Associates Commercial |
$306.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$183.60
|
| Rate for Payer: Midlands Choice Commercial |
$285.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$236.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$211.14
|
| Rate for Payer: United Healthcare Commercial |
$367.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$240.72
|
| Rate for Payer: Wellmark IA HMO WHPI |
$86.50
|
| Rate for Payer: Wellmark IA PPO |
$95.28
|
|
|
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 |
$41.83 |
| 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 |
$80.75
|
| Rate for Payer: Amerigroup Medicare |
$63.63
|
| 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 |
$63.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.97
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$72.45
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.60
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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
|
$21,499.40
|
|
|
Service Code
|
MSDRG 421
|
| Min. Negotiated Rate |
$21,187.81 |
| Max. Negotiated Rate |
$21,499.40 |
| Rate for Payer: Amerigroup Medicaid |
$21,395.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21,187.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21,499.40
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$39,578.09
|
|
|
Service Code
|
MSDRG 420
|
| Min. Negotiated Rate |
$39,004.48 |
| Max. Negotiated Rate |
$39,578.09 |
| Rate for Payer: Amerigroup Medicaid |
$39,386.88
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39,004.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39,578.09
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$11,620.08
|
|
|
Service Code
|
MSDRG 422
|
| Min. Negotiated Rate |
$11,451.67 |
| Max. Negotiated Rate |
$11,620.08 |
| Rate for Payer: Amerigroup Medicaid |
$11,563.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11,451.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,620.08
|
|
