|
Heavy Metals Blood DMCL
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
8037850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Aetna of IA Medicare |
$62.13
|
| Rate for Payer: Amerigroup Medicaid |
$55.01
|
| Rate for Payer: Amerigroup Medicare |
$55.04
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.48
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.50
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.75
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
| Rate for Payer: Wellmark IA HMO |
$37.20
|
| Rate for Payer: Wellmark IA PPO |
$40.92
|
|
|
Helicobacter pylori Antigen Stool
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
8404856
|
|
Hospital Revenue Code
|
306
|
| 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
|
|
|
Helicobacter pylori Antigen Stool
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
8404856
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| 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 |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Helicobacter pylori Antigen Stool DMCL
|
Facility
OP
|
$147.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
8037856
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Aetna of IA Medicare |
$83.79
|
| Rate for Payer: Amerigroup Medicaid |
$74.19
|
| Rate for Payer: Amerigroup Medicare |
$74.24
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$73.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.47
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$73.50
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$74.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$110.25
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.73
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
Helicobacter pylori Antigen Stool DMCL
|
Facility
IP
|
$147.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
8037856
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna of IA Commercial |
$132.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$132.30
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$110.25
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
|
|
HELICOBACTER SERUM ANTIBODY
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
4024785
|
|
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
|
|
|
HELICOBACTER SERUM ANTIBODY
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
4024785
|
|
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
|
|
|
Hematocrit
|
Facility
IP
|
$35.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
1635636
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
|
|
Hematocrit
|
Facility
OP
|
$35.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
1635636
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Aetna of IA Medicare |
$19.95
|
| Rate for Payer: Amerigroup Medicaid |
$17.66
|
| Rate for Payer: Amerigroup Medicare |
$17.68
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.49
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.50
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.25
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.65
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
HEMATOCRIT
|
Facility
OP
|
$34.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
633742
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$36.15 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Aetna of IA Medicare |
$19.38
|
| Rate for Payer: Amerigroup Medicaid |
$17.16
|
| Rate for Payer: Amerigroup Medicare |
$17.17
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.99
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.00
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.50
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
HEMATOCRIT
|
Facility
IP
|
$34.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
633742
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
|
|
HEMI PROSTEHSES ADAPTOR
|
Facility
IP
|
$6,264.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,384.80 |
| Max. Negotiated Rate |
$5,637.60 |
| Rate for Payer: Aetna of IA Commercial |
$5,637.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,637.60
|
| Rate for Payer: Cash Price |
$5,011.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,698.00
|
| Rate for Payer: Medical Associates Commercial |
$4,698.00
|
| Rate for Payer: Midlands Choice Commercial |
$4,384.80
|
| Rate for Payer: United Healthcare Commercial |
$5,637.60
|
|
|
HEMI PROSTEHSES ADAPTOR
|
Facility
OP
|
$6,264.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,130.75 |
| Max. Negotiated Rate |
$5,637.60 |
| Rate for Payer: Aetna of IA Commercial |
$5,637.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,637.60
|
| Rate for Payer: Aetna of IA Medicare |
$3,570.48
|
| Rate for Payer: Amerigroup Medicaid |
$3,161.44
|
| Rate for Payer: Amerigroup Medicare |
$3,163.32
|
| Rate for Payer: Cash Price |
$5,011.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,698.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,132.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,130.75
|
| Rate for Payer: Medical Associates Commercial |
$4,698.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,132.00
|
| Rate for Payer: Midlands Choice Commercial |
$4,384.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,178.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,698.00
|
| Rate for Payer: United Healthcare Commercial |
$5,637.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,695.76
|
|
|
HEMISPHERICAL SHELL 54MM HIP
|
Facility
IP
|
$8,060.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,642.00 |
| Max. Negotiated Rate |
$7,254.00 |
| Rate for Payer: Aetna of IA Commercial |
$7,254.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,254.00
|
| Rate for Payer: Cash Price |
$6,448.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,045.00
|
| Rate for Payer: Medical Associates Commercial |
$6,045.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,642.00
|
| Rate for Payer: United Healthcare Commercial |
$7,254.00
|
|
|
HEMISPHERICAL SHELL 54MM HIP
|
Facility
OP
|
$8,060.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8026163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,028.39 |
| Max. Negotiated Rate |
$7,254.00 |
| Rate for Payer: Aetna of IA Commercial |
$7,254.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,254.00
|
| Rate for Payer: Aetna of IA Medicare |
$4,594.20
|
| Rate for Payer: Amerigroup Medicaid |
$4,067.88
|
| Rate for Payer: Amerigroup Medicare |
$4,070.30
|
| Rate for Payer: Cash Price |
$6,448.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,045.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,030.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,028.39
|
| Rate for Payer: Medical Associates Commercial |
$6,045.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,030.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,642.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,090.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$6,045.00
|
| Rate for Payer: United Healthcare Commercial |
$7,254.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,755.40
|
|
|
HEMISPHERICAL SHELL 58MM
|
Facility
OP
|
$7,751.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,873.95 |
| Max. Negotiated Rate |
$6,975.90 |
| Rate for Payer: Aetna of IA Commercial |
$6,975.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,975.90
|
| Rate for Payer: Aetna of IA Medicare |
$4,418.07
|
| Rate for Payer: Amerigroup Medicaid |
$3,911.93
|
| Rate for Payer: Amerigroup Medicare |
$3,914.26
|
| Rate for Payer: Cash Price |
$6,200.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,813.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,875.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,873.95
|
| Rate for Payer: Medical Associates Commercial |
$5,813.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,875.50
|
| Rate for Payer: Midlands Choice Commercial |
$5,425.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,933.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,813.25
|
| Rate for Payer: United Healthcare Commercial |
$6,975.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,573.09
|
|
|
HEMISPHERICAL SHELL 58MM
|
Facility
IP
|
$7,751.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8046801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,425.70 |
| Max. Negotiated Rate |
$6,975.90 |
| Rate for Payer: Aetna of IA Commercial |
$6,975.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,975.90
|
| Rate for Payer: Cash Price |
$6,200.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,813.25
|
| Rate for Payer: Medical Associates Commercial |
$5,813.25
|
| Rate for Payer: Midlands Choice Commercial |
$5,425.70
|
| Rate for Payer: United Healthcare Commercial |
$6,975.90
|
|
|
HEMISPHERICAL SOLID BACK SHELL
|
Facility
OP
|
$5,357.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,677.43 |
| Max. Negotiated Rate |
$4,821.30 |
| Rate for Payer: Aetna of IA Commercial |
$4,821.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,821.30
|
| Rate for Payer: Aetna of IA Medicare |
$3,053.49
|
| Rate for Payer: Amerigroup Medicaid |
$2,703.68
|
| Rate for Payer: Amerigroup Medicare |
$2,705.28
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,017.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,678.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,677.43
|
| Rate for Payer: Medical Associates Commercial |
$4,017.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,678.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,749.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,718.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,017.75
|
| Rate for Payer: United Healthcare Commercial |
$4,821.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,160.63
|
|
|
HEMISPHERICAL SOLID BACK SHELL
|
Facility
IP
|
$5,357.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,749.90 |
| Max. Negotiated Rate |
$4,821.30 |
| Rate for Payer: Aetna of IA Commercial |
$4,821.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,821.30
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,017.75
|
| Rate for Payer: Medical Associates Commercial |
$4,017.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,749.90
|
| Rate for Payer: United Healthcare Commercial |
$4,821.30
|
|
|
HEMISPHERIC CLUSTER HOLE SHELL-56MM
|
Facility
OP
|
$5,518.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,757.90 |
| Max. Negotiated Rate |
$4,966.20 |
| Rate for Payer: Aetna of IA Commercial |
$4,966.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,966.20
|
| Rate for Payer: Aetna of IA Medicare |
$3,145.26
|
| Rate for Payer: Amerigroup Medicaid |
$2,784.93
|
| Rate for Payer: Amerigroup Medicare |
$2,786.59
|
| Rate for Payer: Cash Price |
$4,414.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,138.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,759.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,757.90
|
| Rate for Payer: Medical Associates Commercial |
$4,138.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,759.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,862.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,800.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,138.50
|
| Rate for Payer: United Healthcare Commercial |
$4,966.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,255.62
|
|
|
HEMISPHERIC CLUSTER HOLE SHELL-56MM
|
Facility
IP
|
$5,518.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,862.60 |
| Max. Negotiated Rate |
$4,966.20 |
| Rate for Payer: Aetna of IA Commercial |
$4,966.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,966.20
|
| Rate for Payer: Cash Price |
$4,414.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,138.50
|
| Rate for Payer: Medical Associates Commercial |
$4,138.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,862.60
|
| Rate for Payer: United Healthcare Commercial |
$4,966.20
|
|
|
HEMISPHERIC CLUSTER HOLE SHELL-58MM
|
Facility
OP
|
$5,518.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,757.90 |
| Max. Negotiated Rate |
$4,966.20 |
| Rate for Payer: Aetna of IA Commercial |
$4,966.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,966.20
|
| Rate for Payer: Aetna of IA Medicare |
$3,145.26
|
| Rate for Payer: Amerigroup Medicaid |
$2,784.93
|
| Rate for Payer: Amerigroup Medicare |
$2,786.59
|
| Rate for Payer: Cash Price |
$4,414.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,138.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,759.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,757.90
|
| Rate for Payer: Medical Associates Commercial |
$4,138.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,759.00
|
| Rate for Payer: Midlands Choice Commercial |
$3,862.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,800.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,138.50
|
| Rate for Payer: United Healthcare Commercial |
$4,966.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,255.62
|
|
|
HEMISPHERIC CLUSTER HOLE SHELL-58MM
|
Facility
IP
|
$5,518.00
|
|
|
Service Code
|
CPT L8699
|
| Hospital Charge Code |
8046798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,862.60 |
| Max. Negotiated Rate |
$4,966.20 |
| Rate for Payer: Aetna of IA Commercial |
$4,966.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,966.20
|
| Rate for Payer: Cash Price |
$4,414.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,138.50
|
| Rate for Payer: Medical Associates Commercial |
$4,138.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,862.60
|
| Rate for Payer: United Healthcare Commercial |
$4,966.20
|
|
|
Hemochromatosis Genotype DMCL
|
Facility
IP
|
$340.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
8694180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$238.00 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna of IA Commercial |
$306.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$306.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$255.00
|
| Rate for Payer: Medical Associates Commercial |
$255.00
|
| Rate for Payer: Midlands Choice Commercial |
$238.00
|
| Rate for Payer: United Healthcare Commercial |
$306.00
|
|
|
Hemochromatosis Genotype DMCL
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
8694180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$143.22 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna of IA Commercial |
$306.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$306.00
|
| Rate for Payer: Aetna of IA Medicare |
$193.80
|
| Rate for Payer: Amerigroup Medicaid |
$171.60
|
| Rate for Payer: Amerigroup Medicare |
$171.70
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$255.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$170.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$169.93
|
| Rate for Payer: Medical Associates Commercial |
$255.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$170.00
|
| Rate for Payer: Midlands Choice Commercial |
$238.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$172.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$255.00
|
| Rate for Payer: United Healthcare Commercial |
$306.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$200.60
|
| Rate for Payer: Wellmark IA HMO |
$143.22
|
| Rate for Payer: Wellmark IA PPO |
$157.54
|
|
