|
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
|
|
|
HOME SLEEP TEST - TYPE 3
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS G0399
|
| Hospital Charge Code |
6174794
|
|
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
|
|
|
HOME SLEEP TEST - TYPE 3
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
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 |
$72.45 |
| 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 |
$92.86
|
| Rate for Payer: Amerigroup Medicare |
$73.17
|
| 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 |
$72.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.96
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.45
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$93.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.32
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
|
|
HORMONE BINDING GLOBULIN
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 84270
|
| Hospital Charge Code |
8093936
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$79.65 |
| 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 |
$102.09
|
| Rate for Payer: Amerigroup Medicare |
$80.45
|
| 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 |
$79.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$101.10
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.65
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.60
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$104.43
|
|
|
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
|
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
|
|
|
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 |
$67.05 |
| 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 |
$85.94
|
| Rate for Payer: Amerigroup Medicare |
$67.72
|
| 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 |
$67.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.11
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.05
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.11
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
|
|
HSG
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
8378905
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$275.80 |
| Max. Negotiated Rate |
$295.50 |
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Cash Price |
$315.20
|
| Rate for Payer: Medical Associates Commercial |
$295.50
|
| Rate for Payer: Midlands Choice Commercial |
$275.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$295.50
|
| Rate for Payer: United Healthcare Commercial |
$291.01
|
|
|
hsTroponin
|
Facility
|
OP
|
$155.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
8712897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$69.75 |
| 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 |
$89.40
|
| Rate for Payer: Amerigroup Medicare |
$70.45
|
| 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 |
$69.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$88.54
|
| Rate for Payer: Medical Associates Commercial |
$116.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.75
|
| Rate for Payer: Midlands Choice Commercial |
$108.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$89.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.21
|
| Rate for Payer: United Healthcare Commercial |
$139.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$91.45
|
|
|
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
|
|
|
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 |
$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
|
|
|
HSV PCR
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8093937
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$89.10 |
| 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 |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| 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 |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.47
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
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 |
$29.25 |
| 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 |
$37.49
|
| Rate for Payer: Amerigroup Medicare |
$29.54
|
| 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 |
$29.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.13
|
| Rate for Payer: Medical Associates Commercial |
$48.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.25
|
| Rate for Payer: Midlands Choice Commercial |
$45.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.64
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.35
|
|
|
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 Papilloma Virus PCR DMCL
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
8037878
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$67.05 |
| 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 |
$85.94
|
| Rate for Payer: Amerigroup Medicare |
$67.72
|
| 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 |
$67.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$85.11
|
| Rate for Payer: Medical Associates Commercial |
$111.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.05
|
| Rate for Payer: Midlands Choice Commercial |
$104.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$86.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.11
|
| Rate for Payer: United Healthcare Commercial |
$134.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.91
|
|
|
human papillomavirus vaccine 9-valent Sus[VDMC]
|
Facility
|
IP
|
$604.53
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
12453261
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$423.17 |
| Max. Negotiated Rate |
$544.07 |
| Rate for Payer: Aetna of IA Commercial |
$544.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$544.07
|
| Rate for Payer: Cash Price |
$483.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$453.39
|
| Rate for Payer: Medical Associates Commercial |
$453.39
|
| Rate for Payer: Midlands Choice Commercial |
$423.17
|
| Rate for Payer: United Healthcare Commercial |
$544.07
|
|
|
human papillomavirus vaccine 9-valent Sus[VDMC]
|
Facility
|
OP
|
$604.53
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
12453261
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$272.04 |
| Max. Negotiated Rate |
$544.07 |
| Rate for Payer: Aetna of IA Commercial |
$544.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$544.07
|
| Rate for Payer: Aetna of IA Medicare |
$344.58
|
| Rate for Payer: Amerigroup Medicaid |
$348.69
|
| Rate for Payer: Amerigroup Medicare |
$274.76
|
| Rate for Payer: Cash Price |
$483.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$453.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$272.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$345.31
|
| Rate for Payer: Medical Associates Commercial |
$453.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$272.04
|
| Rate for Payer: Midlands Choice Commercial |
$423.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$350.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$312.84
|
| Rate for Payer: United Healthcare Commercial |
$544.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$356.67
|
|
|
HUMERAL HEAD
|
Facility
|
OP
|
$3,967.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047292
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,785.15 |
| 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 |
$2,288.17
|
| Rate for Payer: Amerigroup Medicare |
$1,803.00
|
| 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 |
$1,785.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2,265.95
|
| Rate for Payer: Medical Associates Commercial |
$2,975.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,785.15
|
| Rate for Payer: Midlands Choice Commercial |
$2,776.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2,299.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,052.92
|
| Rate for Payer: United Healthcare Commercial |
$3,570.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$2,340.53
|
|
|
HUMERAL HEAD
|
Facility
|
IP
|
$3,967.00
|
|
|
Service Code
|
HCPCS 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 40MM X 17MM
|
Facility
|
OP
|
$3,150.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047278
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,417.50 |
| 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 |
$1,816.92
|
| Rate for Payer: Amerigroup Medicare |
$1,431.67
|
| 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 |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,799.28
|
| Rate for Payer: Medical Associates Commercial |
$2,362.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,205.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,825.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,630.12
|
| Rate for Payer: United Healthcare Commercial |
$2,835.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,858.50
|
|
