|
E0336 RBC CPD AS1 500 LR
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
6702786
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$265.89 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Aetna of IA Medicare |
$303.24
|
| Rate for Payer: Amerigroup Medicaid |
$268.50
|
| Rate for Payer: Amerigroup Medicare |
$268.66
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$266.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$265.89
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$266.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$269.99
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$269.83
|
| Rate for Payer: Oscar Health of IA Commercial |
$399.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E0379 RBC CP2D AS3 500 LR Irr
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT P9040
|
| Hospital Charge Code |
6702804
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$265.89 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Aetna of IA Medicare |
$303.24
|
| Rate for Payer: Amerigroup Medicaid |
$268.50
|
| Rate for Payer: Amerigroup Medicare |
$268.66
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$266.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$265.89
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$266.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$269.99
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$269.83
|
| Rate for Payer: Oscar Health of IA Commercial |
$399.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E0379 RBC CP2D AS3 500 LR Irr
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT P9040
|
| Hospital Charge Code |
6702804
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
|
|
E0382 RBC CP2D AS3 500 LR
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
6702782
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$265.89 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Aetna of IA Medicare |
$303.24
|
| Rate for Payer: Amerigroup Medicaid |
$268.50
|
| Rate for Payer: Amerigroup Medicare |
$268.66
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$266.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$265.89
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$266.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$269.99
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$269.83
|
| Rate for Payer: Oscar Health of IA Commercial |
$399.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E0382 RBC CP2D AS3 500 LR
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
6702782
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
|
|
E0661 Aph RBC CP2D AS3 LR Irr
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT P9040
|
| Hospital Charge Code |
6702817
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$265.89 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Aetna of IA Medicare |
$303.24
|
| Rate for Payer: Amerigroup Medicaid |
$268.50
|
| Rate for Payer: Amerigroup Medicare |
$268.66
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$266.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$265.89
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$266.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$269.99
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$269.83
|
| Rate for Payer: Oscar Health of IA Commercial |
$399.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E0661 Aph RBC CP2D AS3 LR Irr
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT P9040
|
| Hospital Charge Code |
6702817
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
|
|
E0668 Aph RBC CP2D AS3 LR Irr 1
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT P9040
|
| Hospital Charge Code |
6702814
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
|
|
E0668 Aph RBC CP2D AS3 LR Irr 1
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT P9040
|
| Hospital Charge Code |
6702814
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$265.89 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Aetna of IA Medicare |
$303.24
|
| Rate for Payer: Amerigroup Medicaid |
$268.50
|
| Rate for Payer: Amerigroup Medicare |
$268.66
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$266.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$265.89
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$266.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$269.99
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$269.83
|
| Rate for Payer: Oscar Health of IA Commercial |
$399.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E0669 Aph RBC CP2D AS3 LR Irr 2
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT P9040
|
| Hospital Charge Code |
6702785
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
|
|
E0669 Aph RBC CP2D AS3 LR Irr 2
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT P9040
|
| Hospital Charge Code |
6702785
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$265.89 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Aetna of IA Medicare |
$303.24
|
| Rate for Payer: Amerigroup Medicaid |
$268.50
|
| Rate for Payer: Amerigroup Medicare |
$268.66
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$266.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$265.89
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$266.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$269.99
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$269.83
|
| Rate for Payer: Oscar Health of IA Commercial |
$399.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E0678 Aph RBC CP2D AS3 LR
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
6702823
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$265.89 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Aetna of IA Medicare |
$303.24
|
| Rate for Payer: Amerigroup Medicaid |
$268.50
|
| Rate for Payer: Amerigroup Medicare |
$268.66
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$266.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$265.89
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$266.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$269.99
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$269.83
|
| Rate for Payer: Oscar Health of IA Commercial |
$399.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E0678 Aph RBC CP2D AS3 LR
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
6702823
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
|
|
E0685 Aph RBC CP2D AS3 LR 1
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
6702819
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$265.89 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Aetna of IA Medicare |
$303.24
|
| Rate for Payer: Amerigroup Medicaid |
$268.50
|
| Rate for Payer: Amerigroup Medicare |
$268.66
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$266.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$265.89
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$266.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$269.99
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$269.83
|
| Rate for Payer: Oscar Health of IA Commercial |
$399.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E0685 Aph RBC CP2D AS3 LR 1
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
6702819
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
|
|
E0686 Aph RBC CP2D AS3 LR 2
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
6702788
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$265.89 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Aetna of IA Medicare |
$303.24
|
| Rate for Payer: Amerigroup Medicaid |
$268.50
|
| Rate for Payer: Amerigroup Medicare |
$268.66
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$266.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$265.89
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$266.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$269.99
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$269.83
|
| Rate for Payer: Oscar Health of IA Commercial |
$399.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$399.00
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E0686 Aph RBC CP2D AS3 LR 2
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
CPT P9016
|
| Hospital Charge Code |
6702788
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$478.80 |
| Rate for Payer: Aetna of IA Commercial |
$478.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$478.80
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$399.00
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
|
|
E1237 Thawed Aph FFP ACDA
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
6702808
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$97.96 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$176.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$176.40
|
| Rate for Payer: Aetna of IA Medicare |
$111.72
|
| Rate for Payer: Amerigroup Medicaid |
$98.92
|
| Rate for Payer: Amerigroup Medicare |
$98.98
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$98.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.96
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.00
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$99.47
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$99.41
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.00
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$115.64
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E1237 Thawed Aph FFP ACDA
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
6702808
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna of IA Commercial |
$176.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$176.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.00
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
|
|
E2701 Thawed Plasma CPD <24h
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
6702791
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$97.96 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$176.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$176.40
|
| Rate for Payer: Aetna of IA Medicare |
$111.72
|
| Rate for Payer: Amerigroup Medicaid |
$98.92
|
| Rate for Payer: Amerigroup Medicare |
$98.98
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$98.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.96
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.00
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$99.47
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$99.41
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.00
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$115.64
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E2701 Thawed Plasma CPD <24h
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
6702791
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna of IA Commercial |
$176.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$176.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.00
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
|
|
E2737 Thawed Plasma CP2D <24h
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
6702795
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$97.96 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$176.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$176.40
|
| Rate for Payer: Aetna of IA Medicare |
$111.72
|
| Rate for Payer: Amerigroup Medicaid |
$98.92
|
| Rate for Payer: Amerigroup Medicare |
$98.98
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$98.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.96
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$98.00
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$99.47
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$99.41
|
| Rate for Payer: Oscar Health of IA Commercial |
$147.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.00
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$115.64
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
|
E2737 Thawed Plasma CP2D <24h
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT P9017
|
| Hospital Charge Code |
6702795
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna of IA Commercial |
$176.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$176.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$147.00
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
|
|
E3046 Aph Plt ACDA LR Irr
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
6702798
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$616.70 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
|
|
E3046 Aph Plt ACDA LR Irr
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
CPT P9037
|
| Hospital Charge Code |
6702798
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$440.32 |
| Max. Negotiated Rate |
$1,444.48 |
| Rate for Payer: Aetna of IA Commercial |
$792.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$792.90
|
| Rate for Payer: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$444.64
|
| Rate for Payer: Amerigroup Medicare |
$444.90
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Cash Price |
$704.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$660.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$440.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$440.32
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$440.50
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$447.11
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$446.84
|
| Rate for Payer: Oscar Health of IA Commercial |
$660.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$660.75
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO |
$1,313.16
|
| Rate for Payer: Wellmark IA PPO |
$1,444.48
|
|
