|
Helicobacter pylori Antigen Stool DMCL
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 87338
|
| Hospital Charge Code |
8037856
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
HELICOBACTER SERUM ANTIBODY
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 86677
|
| Hospital Charge Code |
4024785
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$41.83 |
| 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: 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
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
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
|
|
|
Hematocrit
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
1635636
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Aetna of IA Medicare |
$19.95
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$15.91
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.75
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.11
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.65
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
Hematocrit
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
1635636
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
|
|
HEMATOCRIT
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
633742
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Aetna of IA Medicare |
$19.38
|
| Rate for Payer: Amerigroup Medicaid |
$19.61
|
| Rate for Payer: Amerigroup Medicare |
$15.45
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.42
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.30
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.60
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.06
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
HEMATOCRIT
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
633742
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of IA Commercial |
$30.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.50
|
| Rate for Payer: Medical Associates Commercial |
$25.50
|
| Rate for Payer: Midlands Choice Commercial |
$23.80
|
| Rate for Payer: United Healthcare Commercial |
$30.60
|
|
|
HEMI PROSTEHSES ADAPTOR
|
Facility
|
OP
|
$6,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,818.80 |
| Max. Negotiated Rate |
$5,637.60 |
| Rate for Payer: Aetna of IA Commercial |
$5,637.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,637.60
|
| Rate for Payer: Aetna of IA Medicare |
$3,570.48
|
| Rate for Payer: Amerigroup Medicaid |
$3,613.08
|
| Rate for Payer: Amerigroup Medicare |
$2,846.99
|
| Rate for Payer: Cash Price |
$5,011.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,698.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,818.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,578.00
|
| Rate for Payer: Medical Associates Commercial |
$4,698.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,818.80
|
| Rate for Payer: Midlands Choice Commercial |
$4,384.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,630.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$3,241.62
|
| Rate for Payer: United Healthcare Commercial |
$5,637.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,695.76
|
|
|
HEMI PROSTEHSES ADAPTOR
|
Facility
|
IP
|
$6,264.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8047295
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,384.80 |
| Max. Negotiated Rate |
$5,637.60 |
| Rate for Payer: Aetna of IA Commercial |
$5,637.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,637.60
|
| Rate for Payer: Cash Price |
$5,011.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,698.00
|
| Rate for Payer: Medical Associates Commercial |
$4,698.00
|
| Rate for Payer: Midlands Choice Commercial |
$4,384.80
|
| Rate for Payer: United Healthcare Commercial |
$5,637.60
|
|
|
HEMISPHERICAL SHELL 54MM HIP
|
Facility
|
OP
|
$8,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,627.00 |
| Max. Negotiated Rate |
$7,254.00 |
| Rate for Payer: Aetna of IA Commercial |
$7,254.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,254.00
|
| Rate for Payer: Aetna of IA Medicare |
$4,594.20
|
| Rate for Payer: Amerigroup Medicaid |
$4,649.01
|
| Rate for Payer: Amerigroup Medicare |
$3,663.27
|
| Rate for Payer: Cash Price |
$6,448.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,045.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,627.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,603.87
|
| Rate for Payer: Medical Associates Commercial |
$6,045.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,627.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,642.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,671.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,171.05
|
| Rate for Payer: United Healthcare Commercial |
$7,254.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,755.40
|
|
|
HEMISPHERICAL SHELL 54MM HIP
|
Facility
|
IP
|
$8,060.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8026163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,642.00 |
| Max. Negotiated Rate |
$7,254.00 |
| Rate for Payer: Aetna of IA Commercial |
$7,254.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7,254.00
|
| Rate for Payer: Cash Price |
$6,448.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6,045.00
|
| Rate for Payer: Medical Associates Commercial |
$6,045.00
|
| Rate for Payer: Midlands Choice Commercial |
$5,642.00
|
| Rate for Payer: United Healthcare Commercial |
$7,254.00
|
|
|
HEMISPHERICAL SHELL 58MM
|
Facility
|
IP
|
$7,751.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,425.70 |
| Max. Negotiated Rate |
$6,975.90 |
| Rate for Payer: Aetna of IA Commercial |
$6,975.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,975.90
|
| Rate for Payer: Cash Price |
$6,200.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,813.25
|
| Rate for Payer: Medical Associates Commercial |
$5,813.25
|
| Rate for Payer: Midlands Choice Commercial |
$5,425.70
|
| Rate for Payer: United Healthcare Commercial |
$6,975.90
|
|
|
HEMISPHERICAL SHELL 58MM
|
Facility
|
OP
|
$7,751.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
8046801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,487.95 |
| Max. Negotiated Rate |
$6,975.90 |
| Rate for Payer: Aetna of IA Commercial |
$6,975.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,975.90
|
| Rate for Payer: Aetna of IA Medicare |
$4,418.07
|
| Rate for Payer: Amerigroup Medicaid |
$4,470.78
|
| Rate for Payer: Amerigroup Medicare |
$3,522.83
|
| Rate for Payer: Cash Price |
$6,200.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,813.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,487.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,427.37
|
| Rate for Payer: Medical Associates Commercial |
$5,813.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,487.95
|
| Rate for Payer: Midlands Choice Commercial |
$5,425.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,492.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,011.14
|
| Rate for Payer: United Healthcare Commercial |
$6,975.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,573.09
|
|
|
HEMISPHERICAL SOLID BACK SHELL
|
Facility
|
OP
|
$5,357.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,410.65 |
| Max. Negotiated Rate |
$4,821.30 |
| Rate for Payer: Aetna of IA Commercial |
$4,821.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,821.30
|
| Rate for Payer: Aetna of IA Medicare |
$3,053.49
|
| Rate for Payer: Amerigroup Medicaid |
$3,089.92
|
| Rate for Payer: Amerigroup Medicare |
$2,434.76
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,017.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,410.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,059.92
|
| Rate for Payer: Medical Associates Commercial |
$4,017.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,410.65
|
| Rate for Payer: Midlands Choice Commercial |
$3,749.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,104.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,772.25
|
| Rate for Payer: United Healthcare Commercial |
$4,821.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,160.63
|
|
|
HEMISPHERICAL SOLID BACK SHELL
|
Facility
|
IP
|
$5,357.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,749.90 |
| Max. Negotiated Rate |
$4,821.30 |
| Rate for Payer: Aetna of IA Commercial |
$4,821.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,821.30
|
| Rate for Payer: Cash Price |
$4,285.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,017.75
|
| Rate for Payer: Medical Associates Commercial |
$4,017.75
|
| Rate for Payer: Midlands Choice Commercial |
$3,749.90
|
| Rate for Payer: United Healthcare Commercial |
$4,821.30
|
|
|
HEMISPHERIC CLUSTER HOLE SHELL-56MM
|
Facility
|
IP
|
$5,518.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,862.60 |
| Max. Negotiated Rate |
$4,966.20 |
| Rate for Payer: Aetna of IA Commercial |
$4,966.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,966.20
|
| Rate for Payer: Cash Price |
$4,414.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,138.50
|
| Rate for Payer: Medical Associates Commercial |
$4,138.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,862.60
|
| Rate for Payer: United Healthcare Commercial |
$4,966.20
|
|
|
HEMISPHERIC CLUSTER HOLE SHELL-56MM
|
Facility
|
OP
|
$5,518.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,483.10 |
| Max. Negotiated Rate |
$4,966.20 |
| Rate for Payer: Aetna of IA Commercial |
$4,966.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,966.20
|
| Rate for Payer: Aetna of IA Medicare |
$3,145.26
|
| Rate for Payer: Amerigroup Medicaid |
$3,182.78
|
| Rate for Payer: Amerigroup Medicare |
$2,507.93
|
| Rate for Payer: Cash Price |
$4,414.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,138.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,483.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,151.88
|
| Rate for Payer: Medical Associates Commercial |
$4,138.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,483.10
|
| Rate for Payer: Midlands Choice Commercial |
$3,862.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,198.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,855.56
|
| Rate for Payer: United Healthcare Commercial |
$4,966.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,255.62
|
|
|
HEMISPHERIC CLUSTER HOLE SHELL-58MM
|
Facility
|
OP
|
$5,518.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,483.10 |
| Max. Negotiated Rate |
$4,966.20 |
| Rate for Payer: Aetna of IA Commercial |
$4,966.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,966.20
|
| Rate for Payer: Aetna of IA Medicare |
$3,145.26
|
| Rate for Payer: Amerigroup Medicaid |
$3,182.78
|
| Rate for Payer: Amerigroup Medicare |
$2,507.93
|
| Rate for Payer: Cash Price |
$4,414.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,138.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,483.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,151.88
|
| Rate for Payer: Medical Associates Commercial |
$4,138.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,483.10
|
| Rate for Payer: Midlands Choice Commercial |
$3,862.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,198.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,855.56
|
| Rate for Payer: United Healthcare Commercial |
$4,966.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,255.62
|
|
|
HEMISPHERIC CLUSTER HOLE SHELL-58MM
|
Facility
|
IP
|
$5,518.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
8046798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,862.60 |
| Max. Negotiated Rate |
$4,966.20 |
| Rate for Payer: Aetna of IA Commercial |
$4,966.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4,966.20
|
| Rate for Payer: Cash Price |
$4,414.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,138.50
|
| Rate for Payer: Medical Associates Commercial |
$4,138.50
|
| Rate for Payer: Midlands Choice Commercial |
$3,862.60
|
| Rate for Payer: United Healthcare Commercial |
$4,966.20
|
|
|
Hemochromatosis Genotype DMCL
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
8694180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$238.00 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna of IA Commercial |
$306.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$306.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$255.00
|
| Rate for Payer: Medical Associates Commercial |
$255.00
|
| Rate for Payer: Midlands Choice Commercial |
$238.00
|
| Rate for Payer: United Healthcare Commercial |
$306.00
|
|
|
Hemochromatosis Genotype DMCL
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
8694180
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$100.68 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna of IA Commercial |
$306.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$306.00
|
| Rate for Payer: Aetna of IA Medicare |
$193.80
|
| Rate for Payer: Amerigroup Medicaid |
$196.11
|
| Rate for Payer: Amerigroup Medicare |
$154.53
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$255.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$153.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$194.21
|
| Rate for Payer: Medical Associates Commercial |
$255.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$153.00
|
| Rate for Payer: Midlands Choice Commercial |
$238.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$197.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$175.95
|
| Rate for Payer: United Healthcare Commercial |
$306.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$200.60
|
| Rate for Payer: Wellmark IA HMO WHPI |
$100.68
|
| Rate for Payer: Wellmark IA PPO |
$110.90
|
|
|
Hemoglobin
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
1635635
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Aetna of IA Medicare |
$19.95
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$15.91
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.75
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.11
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.65
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
Hemoglobin
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
1635635
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
|
|
HEMOGLOBIN
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
|
|
HEMOGLOBIN
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$32.02 |
| Rate for Payer: Aetna of IA Commercial |
$31.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.50
|
| Rate for Payer: Aetna of IA Medicare |
$19.95
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$15.91
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$26.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.75
|
| Rate for Payer: Midlands Choice Commercial |
$24.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.11
|
| Rate for Payer: United Healthcare Commercial |
$31.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.65
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
