|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE
|
Facility
|
IP
|
$4,214.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,949.80 |
| Max. Negotiated Rate |
$3,792.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,792.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,792.60
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,160.50
|
| Rate for Payer: Medical Associates Commercial |
$3,160.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,949.80
|
| Rate for Payer: United Healthcare Commercial |
$3,792.60
|
|
|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE
|
Facility
|
OP
|
$4,214.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,896.30 |
| Max. Negotiated Rate |
$3,792.60 |
| Rate for Payer: Aetna of IA Commercial |
$3,792.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,792.60
|
| Rate for Payer: Aetna of IA Medicare |
$2,401.98
|
| Rate for Payer: Amerigroup Medicaid |
$2,430.64
|
| Rate for Payer: Amerigroup Medicare |
$1,915.26
|
| Rate for Payer: Cash Price |
$3,371.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3,160.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,896.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,407.04
|
| Rate for Payer: Medical Associates Commercial |
$3,160.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,896.30
|
| Rate for Payer: Midlands Choice Commercial |
$2,949.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,442.43
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,180.74
|
| Rate for Payer: United Healthcare Commercial |
$3,792.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,486.26
|
|
|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE-1
|
Facility
|
IP
|
$3,945.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
|
|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE-1
|
Facility
|
OP
|
$3,945.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046927
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.25 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Aetna of IA Medicare |
$2,248.65
|
| Rate for Payer: Amerigroup Medicaid |
$2,275.48
|
| Rate for Payer: Amerigroup Medicare |
$1,793.00
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,775.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,253.38
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,775.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,286.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,041.54
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,327.55
|
|
|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE-2
|
Facility
|
IP
|
$3,945.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,761.50 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
|
|
HIP REPLACEMENT INSERT 36MM POLYETHYLENE-2
|
Facility
|
OP
|
$3,945.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046929
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,775.25 |
| Max. Negotiated Rate |
$3,550.50 |
| Rate for Payer: Aetna of IA Commercial |
$3,550.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3,550.50
|
| Rate for Payer: Aetna of IA Medicare |
$2,248.65
|
| Rate for Payer: Amerigroup Medicaid |
$2,275.48
|
| Rate for Payer: Amerigroup Medicare |
$1,793.00
|
| Rate for Payer: Cash Price |
$3,156.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,958.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,775.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,253.38
|
| Rate for Payer: Medical Associates Commercial |
$2,958.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,775.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,761.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,286.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,041.54
|
| Rate for Payer: United Healthcare Commercial |
$3,550.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,327.55
|
|
|
HIP STEM #13
|
Facility
|
IP
|
$9,255.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,478.50 |
| Max. Negotiated Rate |
$8,329.50 |
| Rate for Payer: Aetna of IA Commercial |
$8,329.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8,329.50
|
| Rate for Payer: Cash Price |
$7,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,941.25
|
| Rate for Payer: Medical Associates Commercial |
$6,941.25
|
| Rate for Payer: Midlands Choice Commercial |
$6,478.50
|
| Rate for Payer: United Healthcare Commercial |
$8,329.50
|
|
|
HIP STEM #13
|
Facility
|
OP
|
$9,255.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,164.75 |
| Max. Negotiated Rate |
$8,329.50 |
| Rate for Payer: Aetna of IA Commercial |
$8,329.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8,329.50
|
| Rate for Payer: Aetna of IA Medicare |
$5,275.35
|
| Rate for Payer: Amerigroup Medicaid |
$5,338.28
|
| Rate for Payer: Amerigroup Medicare |
$4,206.40
|
| Rate for Payer: Cash Price |
$7,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,941.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,164.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,286.46
|
| Rate for Payer: Medical Associates Commercial |
$6,941.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,164.75
|
| Rate for Payer: Midlands Choice Commercial |
$6,478.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,364.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,789.46
|
| Rate for Payer: United Healthcare Commercial |
$8,329.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$5,460.45
|
|
|
HIP STEM #6
|
Facility
|
IP
|
$9,255.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,478.50 |
| Max. Negotiated Rate |
$8,329.50 |
| Rate for Payer: Aetna of IA Commercial |
$8,329.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8,329.50
|
| Rate for Payer: Cash Price |
$7,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,941.25
|
| Rate for Payer: Medical Associates Commercial |
$6,941.25
|
| Rate for Payer: Midlands Choice Commercial |
$6,478.50
|
| Rate for Payer: United Healthcare Commercial |
$8,329.50
|
|
|
HIP STEM #6
|
Facility
|
OP
|
$9,255.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046308
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,164.75 |
| Max. Negotiated Rate |
$8,329.50 |
| Rate for Payer: Aetna of IA Commercial |
$8,329.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8,329.50
|
| Rate for Payer: Aetna of IA Medicare |
$5,275.35
|
| Rate for Payer: Amerigroup Medicaid |
$5,338.28
|
| Rate for Payer: Amerigroup Medicare |
$4,206.40
|
| Rate for Payer: Cash Price |
$7,404.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,941.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4,164.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,286.46
|
| Rate for Payer: Medical Associates Commercial |
$6,941.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$4,164.75
|
| Rate for Payer: Midlands Choice Commercial |
$6,478.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,364.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,789.46
|
| Rate for Payer: United Healthcare Commercial |
$8,329.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$5,460.45
|
|
|
Histoplasmosis Immunodiffusion DMCL
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
8037874
|
|
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
|
|
|
Histoplasmosis Immunodiffusion DMCL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
8037874
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$51.30 |
| 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 |
$65.76
|
| Rate for Payer: Amerigroup Medicare |
$51.81
|
| 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 |
$51.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$65.12
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.30
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$66.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$58.99
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
|
|
HIV 1 2 DMCL
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
8037875
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of IA Commercial |
$81.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.90
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$68.25
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
|
|
HIV 1 2 DMCL
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT 87389
|
| Hospital Charge Code |
8037875
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of IA Commercial |
$81.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.90
|
| Rate for Payer: Aetna of IA Medicare |
$51.87
|
| Rate for Payer: Amerigroup Medicaid |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$41.36
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$68.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$40.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.95
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.09
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.69
|
|
|
HIV IN HOUSE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS G0433
|
| Hospital Charge Code |
4017669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of IA Commercial |
$68.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.40
|
| Rate for Payer: Aetna of IA Medicare |
$43.32
|
| Rate for Payer: Amerigroup Medicaid |
$43.84
|
| Rate for Payer: Amerigroup Medicare |
$34.54
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.41
|
| Rate for Payer: Medical Associates Commercial |
$57.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.20
|
| Rate for Payer: Midlands Choice Commercial |
$53.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.33
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.84
|
|
|
HIV IN HOUSE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS G0433
|
| Hospital Charge Code |
633757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of IA Commercial |
$68.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.40
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.00
|
| Rate for Payer: Medical Associates Commercial |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$53.20
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
|
|
HIV IN HOUSE
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS G0433
|
| Hospital Charge Code |
4017669
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of IA Commercial |
$68.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.40
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.00
|
| Rate for Payer: Medical Associates Commercial |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$53.20
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
|
|
HIV IN HOUSE
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS G0433
|
| Hospital Charge Code |
633757
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna of IA Commercial |
$68.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.40
|
| Rate for Payer: Aetna of IA Medicare |
$43.32
|
| Rate for Payer: Amerigroup Medicaid |
$43.84
|
| Rate for Payer: Amerigroup Medicare |
$34.54
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.41
|
| Rate for Payer: Medical Associates Commercial |
$57.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.20
|
| Rate for Payer: Midlands Choice Commercial |
$53.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.33
|
| Rate for Payer: United Healthcare Commercial |
$68.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.84
|
|
|
HLA B27 Blood DMCL
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
8519282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of IA Commercial |
$136.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$136.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.00
|
| Rate for Payer: Medical Associates Commercial |
$114.00
|
| Rate for Payer: Midlands Choice Commercial |
$106.40
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
|
|
HLA B27 Blood DMCL
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
8519282
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of IA Commercial |
$136.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$136.80
|
| Rate for Payer: Aetna of IA Medicare |
$86.64
|
| Rate for Payer: Amerigroup Medicaid |
$87.67
|
| Rate for Payer: Amerigroup Medicare |
$69.08
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$68.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.82
|
| Rate for Payer: Medical Associates Commercial |
$114.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$68.40
|
| Rate for Payer: Midlands Choice Commercial |
$106.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$88.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.66
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.68
|
|
|
Holter Monitor 24 Hour RT
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
7068790
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
|
|
Holter Monitor 24 Hour RT
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
7068790
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Aetna of IA Medicare |
$216.60
|
| Rate for Payer: Amerigroup Medicaid |
$219.18
|
| Rate for Payer: Amerigroup Medicare |
$172.71
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$171.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$217.06
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$171.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$196.65
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$224.20
|
|
|
Holter Monitor 48 Hour RT
|
Facility
|
IP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
7068791
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
|
|
Holter Monitor 48 Hour RT
|
Facility
|
OP
|
$380.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
7068791
|
|
Hospital Revenue Code
|
731
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$342.00 |
| Rate for Payer: Aetna of IA Commercial |
$342.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$342.00
|
| Rate for Payer: Aetna of IA Medicare |
$216.60
|
| Rate for Payer: Amerigroup Medicaid |
$219.18
|
| Rate for Payer: Amerigroup Medicare |
$172.71
|
| Rate for Payer: Cash Price |
$304.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$285.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$171.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$217.06
|
| Rate for Payer: Medical Associates Commercial |
$285.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$171.00
|
| Rate for Payer: Midlands Choice Commercial |
$266.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$220.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$196.65
|
| Rate for Payer: United Healthcare Commercial |
$342.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$224.20
|
|
|
HOME SLEEP TEST - TYPE 3
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS G0399
|
| Hospital Charge Code |
6658835
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$157.50 |
| 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: Aetna of IA Medicare |
$199.50
|
| Rate for Payer: Amerigroup Medicaid |
$201.88
|
| Rate for Payer: Amerigroup Medicare |
$159.07
|
| 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 |
$157.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$199.92
|
| Rate for Payer: Medical Associates Commercial |
$262.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$157.50
|
| Rate for Payer: Midlands Choice Commercial |
$245.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$202.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$181.12
|
| Rate for Payer: United Healthcare Commercial |
$315.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$206.50
|
|
