|
haloperidol 5 mg Tab [VDMC]
|
Facility
|
OP
|
$2.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22237159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of IA Commercial |
$1.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.90
|
| Rate for Payer: Aetna of IA Medicare |
$1.20
|
| Rate for Payer: Amerigroup Medicaid |
$1.22
|
| Rate for Payer: Amerigroup Medicare |
$0.96
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.59
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.21
|
| Rate for Payer: Medical Associates Commercial |
$1.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$1.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.09
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.25
|
|
|
haloperidol 5 mg Tab [VDMC]
|
Facility
|
IP
|
$2.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
22237159
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna of IA Commercial |
$1.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.90
|
| Rate for Payer: Cash Price |
$1.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.59
|
| Rate for Payer: Medical Associates Commercial |
$1.59
|
| Rate for Payer: Midlands Choice Commercial |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.90
|
|
|
haloperidol decanoate 50mg/ml vial [VDMC]
|
Facility
|
OP
|
$51.16
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10429370
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$46.04 |
| Rate for Payer: Aetna of IA Commercial |
$46.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.04
|
| Rate for Payer: Aetna of IA Medicare |
$29.16
|
| Rate for Payer: Amerigroup Medicaid |
$29.51
|
| Rate for Payer: Amerigroup Medicare |
$23.25
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.22
|
| Rate for Payer: Medical Associates Commercial |
$38.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.02
|
| Rate for Payer: Midlands Choice Commercial |
$35.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.48
|
| Rate for Payer: United Healthcare Commercial |
$46.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.18
|
|
|
haloperidol decanoate 50mg/ml vial [VDMC]
|
Facility
|
IP
|
$51.16
|
|
|
Service Code
|
HCPCS J1631
|
| Hospital Charge Code |
10429370
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.81 |
| Max. Negotiated Rate |
$46.04 |
| Rate for Payer: Aetna of IA Commercial |
$46.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.04
|
| Rate for Payer: Cash Price |
$40.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.37
|
| Rate for Payer: Medical Associates Commercial |
$38.37
|
| Rate for Payer: Midlands Choice Commercial |
$35.81
|
| Rate for Payer: United Healthcare Commercial |
$46.04
|
|
|
HAMMER TOE IMPLANT 2.6MM X 2.4MM X 12MM
|
Facility
|
OP
|
$1,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8757474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.00 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,296.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,296.00
|
| Rate for Payer: Aetna of IA Medicare |
$820.80
|
| Rate for Payer: Amerigroup Medicaid |
$830.59
|
| Rate for Payer: Amerigroup Medicare |
$654.48
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,080.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$648.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$822.53
|
| Rate for Payer: Medical Associates Commercial |
$1,080.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$648.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,008.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$834.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$745.20
|
| Rate for Payer: United Healthcare Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$849.60
|
|
|
HAMMER TOE IMPLANT 2.6MM X 2.4MM X 12MM
|
Facility
|
IP
|
$1,440.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8757474
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.00 |
| Max. Negotiated Rate |
$1,296.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,296.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,296.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,080.00
|
| Rate for Payer: Medical Associates Commercial |
$1,080.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare Commercial |
$1,296.00
|
|
|
HAMMER TOE IMPLANT 2.6MMX2.4MMX14MM
|
Facility
|
OP
|
$2,223.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8865233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,000.35 |
| Max. Negotiated Rate |
$2,000.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,000.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,000.70
|
| Rate for Payer: Aetna of IA Medicare |
$1,267.11
|
| Rate for Payer: Amerigroup Medicaid |
$1,282.23
|
| Rate for Payer: Amerigroup Medicare |
$1,010.35
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,667.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,000.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,269.78
|
| Rate for Payer: Medical Associates Commercial |
$1,667.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,000.35
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,288.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,150.40
|
| Rate for Payer: United Healthcare Commercial |
$2,000.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,311.57
|
|
|
HAMMER TOE IMPLANT 2.6MMX2.4MMX14MM
|
Facility
|
IP
|
$2,223.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8865233
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.10 |
| Max. Negotiated Rate |
$2,000.70 |
| Rate for Payer: Aetna of IA Commercial |
$2,000.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,000.70
|
| Rate for Payer: Cash Price |
$1,778.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,667.25
|
| Rate for Payer: Medical Associates Commercial |
$1,667.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,556.10
|
| Rate for Payer: United Healthcare Commercial |
$2,000.70
|
|
|
HAMMER TOE IMPLANT 2.6MM X 2.4MM X 16MM
|
Facility
|
OP
|
$2,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8757476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,106.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,106.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,333.80
|
| Rate for Payer: Amerigroup Medicaid |
$1,349.71
|
| Rate for Payer: Amerigroup Medicare |
$1,063.53
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,755.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,053.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,336.61
|
| Rate for Payer: Medical Associates Commercial |
$1,755.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,053.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,638.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,356.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,210.95
|
| Rate for Payer: United Healthcare Commercial |
$2,106.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,380.60
|
|
|
HAMMER TOE IMPLANT 2.6MM X 2.4MM X 16MM
|
Facility
|
IP
|
$2,340.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8757476
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.00 |
| Max. Negotiated Rate |
$2,106.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,106.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,106.00
|
| Rate for Payer: Cash Price |
$1,872.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,755.00
|
| Rate for Payer: Medical Associates Commercial |
$1,755.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,638.00
|
| Rate for Payer: United Healthcare Commercial |
$2,106.00
|
|
|
Haptoglobin DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
8037849
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.55 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$80.18
|
| Rate for Payer: Amerigroup Medicare |
$63.18
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$62.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.40
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$62.55
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.93
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
|
|
Haptoglobin DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
8037849
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
HCG FREE ALPHA SUBUNIT
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
8086833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Aetna of IA Medicare |
$70.11
|
| Rate for Payer: Amerigroup Medicaid |
$70.95
|
| Rate for Payer: Amerigroup Medicare |
$55.90
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.26
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.35
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.65
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.57
|
|
|
HCG FREE ALPHA SUBUNIT
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
8086833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
|
|
HDL-CHOLESTEROL
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
1628889
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.15 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna of IA Commercial |
$60.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.30
|
| Rate for Payer: Aetna of IA Medicare |
$38.19
|
| Rate for Payer: Amerigroup Medicaid |
$38.65
|
| Rate for Payer: Amerigroup Medicare |
$30.45
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.27
|
| Rate for Payer: Medical Associates Commercial |
$50.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.15
|
| Rate for Payer: Midlands Choice Commercial |
$46.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.67
|
| Rate for Payer: United Healthcare Commercial |
$60.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.53
|
|
|
HDL-CHOLESTEROL
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
1628889
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.90 |
| Max. Negotiated Rate |
$60.30 |
| Rate for Payer: Aetna of IA Commercial |
$60.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.30
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.25
|
| Rate for Payer: Medical Associates Commercial |
$50.25
|
| Rate for Payer: Midlands Choice Commercial |
$46.90
|
| Rate for Payer: United Healthcare Commercial |
$60.30
|
|
|
HEADED SHORT THREAD SCREW 4.5X4.0MM
|
Facility
|
IP
|
$513.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8852827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.10 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
|
|
HEADED SHORT THREAD SCREW 4.5X4.0MM
|
Facility
|
OP
|
$513.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8852827
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.85 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna of IA Commercial |
$461.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$461.70
|
| Rate for Payer: Aetna of IA Medicare |
$292.41
|
| Rate for Payer: Amerigroup Medicaid |
$295.90
|
| Rate for Payer: Amerigroup Medicare |
$233.16
|
| Rate for Payer: Cash Price |
$410.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$384.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$230.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$293.03
|
| Rate for Payer: Medical Associates Commercial |
$384.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$230.85
|
| Rate for Payer: Midlands Choice Commercial |
$359.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$297.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$265.48
|
| Rate for Payer: United Healthcare Commercial |
$461.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$302.67
|
|
|
Heavy Metals Blood DMCL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
8037850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.05 |
| 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 |
$62.87
|
| Rate for Payer: Amerigroup Medicare |
$49.54
|
| 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 |
$49.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.26
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.05
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.41
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
|
|
Heavy Metals Blood DMCL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
8037850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.30 |
| 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: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
|
|
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 |
$53.10 |
| 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: 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
|
|
|
Helicobacter pylori Antigen Stool DMCL
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
8037856
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.15 |
| 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 |
$84.79
|
| Rate for Payer: Amerigroup Medicare |
$66.81
|
| 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 |
$66.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$83.97
|
| Rate for Payer: Medical Associates Commercial |
$110.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$66.15
|
| Rate for Payer: Midlands Choice Commercial |
$102.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$85.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$76.07
|
| Rate for Payer: United Healthcare Commercial |
$132.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.73
|
|
|
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
|
|
