|
HOME SLEEP TEST - TYPE 3
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT G0399
|
| Hospital Charge Code |
6174794
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$403.74 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Aetna of IA Medicare |
$199.50
|
| Rate for Payer: Amerigroup Medicaid |
$176.64
|
| Rate for Payer: Amerigroup Medicare |
$176.75
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$175.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$174.93
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$175.00
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$177.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$262.50
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$206.50
|
| Rate for Payer: Wellmark IA HMO |
$367.04
|
| Rate for Payer: Wellmark IA PPO |
$403.74
|
|
|
HOME SLEEP TEST - TYPE 3
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT G0399
|
| Hospital Charge Code |
6174794
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
|
|
HOME SLEEP TEST - TYPE 3 PORTA
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT G0399
|
| Hospital Charge Code |
6658835
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$403.74 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Aetna of IA Medicare |
$199.50
|
| Rate for Payer: Amerigroup Medicaid |
$176.64
|
| Rate for Payer: Amerigroup Medicare |
$176.75
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$175.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$174.93
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$175.00
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$177.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$262.50
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$206.50
|
| Rate for Payer: Wellmark IA HMO |
$367.04
|
| Rate for Payer: Wellmark IA PPO |
$403.74
|
|
|
HOME SLEEP TEST - TYPE 3 PORTA
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT G0399
|
| Hospital Charge Code |
6658835
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$245.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of IA Commercial |
$315.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$315.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$262.50
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
|
|
Homocysteine DMCL
|
Facility
IP
|
$161.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
8037876
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
Homocysteine DMCL
|
Facility
OP
|
$161.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
8037876
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$81.26
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.47
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.50
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
HORMONE BINDING GLOBULIN
|
Facility
OP
|
$177.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
8093936
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Aetna of IA Medicare |
$100.89
|
| Rate for Payer: Amerigroup Medicaid |
$89.33
|
| Rate for Payer: Amerigroup Medicare |
$89.38
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$88.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$88.46
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.50
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$89.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$132.75
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$104.43
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
HORMONE BINDING GLOBULIN
|
Facility
IP
|
$177.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
8093936
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
|
|
HPV mRNA E6/E7 with RFLX DMCL
|
Facility
OP
|
$149.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
8810258
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Aetna of IA Medicare |
$84.93
|
| Rate for Payer: Amerigroup Medicaid |
$75.20
|
| Rate for Payer: Amerigroup Medicare |
$75.24
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$74.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.47
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.50
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.75
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
HPV mRNA E6/E7 with RFLX DMCL
|
Facility
IP
|
$149.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
8810258
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$104.30 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
|
|
hsTroponin
|
Facility
IP
|
$155.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
8712897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna of IA Commercial |
$139.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$139.50
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$116.25
|
| Rate for Payer: Medical Associates Commercial |
$116.25
|
| Rate for Payer: Midlands Choice Commercial |
$108.50
|
| Rate for Payer: United Healthcare Commercial |
$139.50
|
|
|
hsTroponin
|
Facility
OP
|
$155.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
8712897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna of IA Commercial |
$139.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$139.50
|
| Rate for Payer: Aetna of IA Medicare |
$88.35
|
| Rate for Payer: Amerigroup Medicaid |
$78.23
|
| Rate for Payer: Amerigroup Medicare |
$78.28
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$116.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$77.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.47
|
| Rate for Payer: Medical Associates Commercial |
$116.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$77.50
|
| Rate for Payer: Midlands Choice Commercial |
$108.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$78.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$116.25
|
| Rate for Payer: United Healthcare Commercial |
$139.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$91.45
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
HSV 1 2 IgG Ab DMCL
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
8037871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
HSV 1 2 IgG Ab DMCL
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
8037871
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
HSV PCR
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8093937
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
HSV PCR
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8093937
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
HSV TYPE 2
|
Facility
IP
|
$65.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
8094269
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of IA Commercial |
$58.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.50
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.75
|
| Rate for Payer: Medical Associates Commercial |
$48.75
|
| Rate for Payer: Midlands Choice Commercial |
$45.50
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
|
|
HSV TYPE 2
|
Facility
OP
|
$65.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
8094269
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$58.50 |
| Rate for Payer: Aetna of IA Commercial |
$58.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.50
|
| Rate for Payer: Aetna of IA Medicare |
$37.05
|
| Rate for Payer: Amerigroup Medicaid |
$32.81
|
| Rate for Payer: Amerigroup Medicare |
$32.82
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.49
|
| Rate for Payer: Medical Associates Commercial |
$48.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.50
|
| Rate for Payer: Midlands Choice Commercial |
$45.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.99
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.75
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.35
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Human Papilloma Virus PCR DMCL
|
Facility
OP
|
$149.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
8037878
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Aetna of IA Medicare |
$84.93
|
| Rate for Payer: Amerigroup Medicaid |
$75.20
|
| Rate for Payer: Amerigroup Medicare |
$75.24
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$74.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$74.47
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.50
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.75
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
Human Papilloma Virus PCR DMCL
|
Facility
IP
|
$149.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
8037878
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$104.30 |
| Max. Negotiated Rate |
$134.10 |
| Rate for Payer: Aetna of IA Commercial |
$134.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$134.10
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.75
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
|
|
human papillomavirus vaccine 9-valent Sus
|
Facility
IP
|
$566.38
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
43700439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$396.47 |
| Max. Negotiated Rate |
$509.74 |
| Rate for Payer: Aetna of IA Commercial |
$509.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$509.74
|
| Rate for Payer: Cash Price |
$453.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$424.78
|
| Rate for Payer: Medical Associates Commercial |
$424.78
|
| Rate for Payer: Midlands Choice Commercial |
$396.47
|
| Rate for Payer: United Healthcare Commercial |
$509.74
|
|
|
human papillomavirus vaccine 9-valent Sus
|
Facility
OP
|
$566.38
|
|
|
Service Code
|
CPT 90651
|
| Hospital Charge Code |
43700439
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.70 |
| Max. Negotiated Rate |
$509.74 |
| Rate for Payer: Aetna of IA Commercial |
$509.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$509.74
|
| Rate for Payer: Aetna of IA Medicare |
$322.84
|
| Rate for Payer: Amerigroup Medicaid |
$285.85
|
| Rate for Payer: Amerigroup Medicare |
$286.02
|
| Rate for Payer: Cash Price |
$453.11
|
| Rate for Payer: Cash Price |
$453.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$424.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$283.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$283.08
|
| Rate for Payer: Medical Associates Commercial |
$424.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$283.19
|
| Rate for Payer: Midlands Choice Commercial |
$396.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$287.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$424.78
|
| Rate for Payer: United Healthcare Commercial |
$509.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$334.16
|
| Rate for Payer: Wellmark IA HMO |
$207.70
|
| Rate for Payer: Wellmark IA PPO |
$228.47
|
|
|
HUMERAL HEAD
|
Facility
IP
|
$3,967.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,776.90 |
| Max. Negotiated Rate |
$3,570.30 |
| Rate for Payer: Aetna of IA Commercial |
$3,570.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,570.30
|
| Rate for Payer: Cash Price |
$3,173.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,975.25
|
| Rate for Payer: Medical Associates Commercial |
$2,975.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,776.90
|
| Rate for Payer: United Healthcare Commercial |
$3,570.30
|
|
|
HUMERAL HEAD
|
Facility
OP
|
$3,967.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,982.71 |
| Max. Negotiated Rate |
$3,570.30 |
| Rate for Payer: Aetna of IA Commercial |
$3,570.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,570.30
|
| Rate for Payer: Aetna of IA Medicare |
$2,261.19
|
| Rate for Payer: Amerigroup Medicaid |
$2,002.14
|
| Rate for Payer: Amerigroup Medicare |
$2,003.34
|
| Rate for Payer: Cash Price |
$3,173.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,975.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,983.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,982.71
|
| Rate for Payer: Medical Associates Commercial |
$2,975.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,983.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,776.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,013.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,975.25
|
| Rate for Payer: United Healthcare Commercial |
$3,570.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,340.53
|
|
|
HUMERAL HEAD 40MM X 17MM
|
Facility
OP
|
$3,150.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
8047278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,574.37 |
| Max. Negotiated Rate |
$2,835.00 |
| Rate for Payer: Aetna of IA Commercial |
$2,835.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,835.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,795.50
|
| Rate for Payer: Amerigroup Medicaid |
$1,589.80
|
| Rate for Payer: Amerigroup Medicare |
$1,590.75
|
| Rate for Payer: Cash Price |
$2,520.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,362.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,575.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,574.37
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,575.00
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,598.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,362.50
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,858.50
|
|
