|
E0678 Aph RBC CP2D AS3 LR
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
6702823
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$505.31 |
| 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 |
$306.86
|
| Rate for Payer: Amerigroup Medicare |
$241.79
|
| 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 |
$239.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$303.88
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$239.40
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$308.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$275.31
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO WHPI |
$458.72
|
| Rate for Payer: Wellmark IA PPO |
$505.31
|
|
|
E0678 Aph RBC CP2D AS3 LR
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS P9016
|
| Hospital Charge Code |
6702819
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$505.31 |
| 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 |
$306.86
|
| Rate for Payer: Amerigroup Medicare |
$241.79
|
| 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 |
$239.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$303.88
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$239.40
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$308.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$275.31
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO WHPI |
$458.72
|
| Rate for Payer: Wellmark IA PPO |
$505.31
|
|
|
E0685 Aph RBC CP2D AS3 LR 1
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS 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
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
E0686 Aph RBC CP2D AS3 LR 2
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
6702788
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$239.40 |
| Max. Negotiated Rate |
$505.31 |
| 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 |
$306.86
|
| Rate for Payer: Amerigroup Medicare |
$241.79
|
| 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 |
$239.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$303.88
|
| Rate for Payer: Medical Associates Commercial |
$399.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$239.40
|
| Rate for Payer: Midlands Choice Commercial |
$372.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$308.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$275.31
|
| Rate for Payer: United Healthcare Commercial |
$478.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$313.88
|
| Rate for Payer: Wellmark IA HMO WHPI |
$458.72
|
| Rate for Payer: Wellmark IA PPO |
$505.31
|
|
|
E1237 Thawed Aph FFP ACDA
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
E1237 Thawed Aph FFP ACDA
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
6702808
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$505.31 |
| 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 |
$113.05
|
| Rate for Payer: Amerigroup Medicare |
$89.08
|
| 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 |
$88.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.96
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.20
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$113.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.43
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$115.64
|
| Rate for Payer: Wellmark IA HMO WHPI |
$458.72
|
| Rate for Payer: Wellmark IA PPO |
$505.31
|
|
|
E2701 Thawed Plasma CPD <24h
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
6702791
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$505.31 |
| 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 |
$113.05
|
| Rate for Payer: Amerigroup Medicare |
$89.08
|
| 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 |
$88.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.96
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.20
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$113.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.43
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$115.64
|
| Rate for Payer: Wellmark IA HMO WHPI |
$458.72
|
| Rate for Payer: Wellmark IA PPO |
$505.31
|
|
|
E2701 Thawed Plasma CPD <24h
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS 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
|
HCPCS P9017
|
| Hospital Charge Code |
6702795
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$505.31 |
| 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 |
$113.05
|
| Rate for Payer: Amerigroup Medicare |
$89.08
|
| 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 |
$88.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$111.96
|
| Rate for Payer: Medical Associates Commercial |
$147.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$88.20
|
| Rate for Payer: Midlands Choice Commercial |
$137.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$113.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.43
|
| Rate for Payer: United Healthcare Commercial |
$176.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$115.64
|
| Rate for Payer: Wellmark IA HMO WHPI |
$458.72
|
| Rate for Payer: Wellmark IA PPO |
$505.31
|
|
|
E2737 Thawed Plasma CP2D <24h
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
HCPCS 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
|
OP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
6702798
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$396.45 |
| 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: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$508.16
|
| Rate for Payer: Amerigroup Medicare |
$400.41
|
| 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 |
$396.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$503.23
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$396.45
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$510.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$455.92
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$528.21
|
| Rate for Payer: Wellmark IA PPO |
$581.85
|
|
|
E3046 Aph Plt ACDA LR Irr
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
HCPCS 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
|
|
|
E3056 Aph Plt ACDA LR Irr 1
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
6702799
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$396.45 |
| 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: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$508.16
|
| Rate for Payer: Amerigroup Medicare |
$400.41
|
| 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 |
$396.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$503.23
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$396.45
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$510.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$455.92
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$528.21
|
| Rate for Payer: Wellmark IA PPO |
$581.85
|
|
|
E3056 Aph Plt ACDA LR Irr 1
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
6702799
|
|
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
|
|
|
E3057 Aph Plt ACDA LR Irr 2
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
6702805
|
|
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
|
|
|
E3057 Aph Plt ACDA LR Irr 2
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
6702805
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$396.45 |
| 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: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$508.16
|
| Rate for Payer: Amerigroup Medicare |
$400.41
|
| 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 |
$396.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$503.23
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$396.45
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$510.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$455.92
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$528.21
|
| Rate for Payer: Wellmark IA PPO |
$581.85
|
|
|
E3058 Aph Plt ACDA LR Irr 3
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
6702813
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$396.45 |
| 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: Aetna of IA Medicare |
$502.17
|
| Rate for Payer: Amerigroup Medicaid |
$508.16
|
| Rate for Payer: Amerigroup Medicare |
$400.41
|
| 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 |
$396.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$503.23
|
| Rate for Payer: Medical Associates Commercial |
$660.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$396.45
|
| Rate for Payer: Midlands Choice Commercial |
$616.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$510.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$455.92
|
| Rate for Payer: United Healthcare Commercial |
$792.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$519.79
|
| Rate for Payer: Wellmark IA HMO WHPI |
$528.21
|
| Rate for Payer: Wellmark IA PPO |
$581.85
|
|
|
E3058 Aph Plt ACDA LR Irr 3
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
6702813
|
|
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
|
|
|
E3077 Aph Plt ACDA LR
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
6702822
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$438.30 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Aetna of IA Commercial |
$876.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$876.60
|
| Rate for Payer: Aetna of IA Medicare |
$555.18
|
| Rate for Payer: Amerigroup Medicaid |
$561.80
|
| Rate for Payer: Amerigroup Medicare |
$442.68
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$730.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$438.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$556.35
|
| Rate for Payer: Medical Associates Commercial |
$730.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$438.30
|
| Rate for Payer: Midlands Choice Commercial |
$681.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$564.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$504.04
|
| Rate for Payer: United Healthcare Commercial |
$876.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$574.66
|
| Rate for Payer: Wellmark IA HMO WHPI |
$528.21
|
| Rate for Payer: Wellmark IA PPO |
$581.85
|
|
|
E3077 Aph Plt ACDA LR
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
6702822
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$681.80 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Aetna of IA Commercial |
$876.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$876.60
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$730.50
|
| Rate for Payer: Medical Associates Commercial |
$730.50
|
| Rate for Payer: Midlands Choice Commercial |
$681.80
|
| Rate for Payer: United Healthcare Commercial |
$876.60
|
|
|
E3087 Aph Plt ACDA LR 1
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
6702789
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$438.30 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Aetna of IA Commercial |
$876.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$876.60
|
| Rate for Payer: Aetna of IA Medicare |
$555.18
|
| Rate for Payer: Amerigroup Medicaid |
$561.80
|
| Rate for Payer: Amerigroup Medicare |
$442.68
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$730.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$438.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$556.35
|
| Rate for Payer: Medical Associates Commercial |
$730.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$438.30
|
| Rate for Payer: Midlands Choice Commercial |
$681.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$564.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$504.04
|
| Rate for Payer: United Healthcare Commercial |
$876.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$574.66
|
| Rate for Payer: Wellmark IA HMO WHPI |
$528.21
|
| Rate for Payer: Wellmark IA PPO |
$581.85
|
|
|
E3087 Aph Plt ACDA LR 1
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
6702789
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$681.80 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Aetna of IA Commercial |
$876.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$876.60
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$730.50
|
| Rate for Payer: Medical Associates Commercial |
$730.50
|
| Rate for Payer: Midlands Choice Commercial |
$681.80
|
| Rate for Payer: United Healthcare Commercial |
$876.60
|
|
|
E3088 Aph Plt ACDA LR 2
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
6702803
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$438.30 |
| Max. Negotiated Rate |
$876.60 |
| Rate for Payer: Aetna of IA Commercial |
$876.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$876.60
|
| Rate for Payer: Aetna of IA Medicare |
$555.18
|
| Rate for Payer: Amerigroup Medicaid |
$561.80
|
| Rate for Payer: Amerigroup Medicare |
$442.68
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Cash Price |
$779.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$730.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$438.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$556.35
|
| Rate for Payer: Medical Associates Commercial |
$730.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$438.30
|
| Rate for Payer: Midlands Choice Commercial |
$681.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$564.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$504.04
|
| Rate for Payer: United Healthcare Commercial |
$876.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$574.66
|
| Rate for Payer: Wellmark IA HMO WHPI |
$528.21
|
| Rate for Payer: Wellmark IA PPO |
$581.85
|
|
