|
E3088 Aph Plt ACDA LR 2
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
6702803
|
|
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
|
|
|
E3089 Aph Plt ACDA LR 3
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
6702796
|
|
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
|
|
|
E3089 Aph Plt ACDA LR 3
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
6702796
|
|
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
|
|
|
E4526 Aph RBC ACDA AS1 LR Irr
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8053739
|
|
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
|
|
|
E4526 Aph RBC ACDA AS1 LR Irr
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8053739
|
|
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
|
|
|
E4527 Aph RBC ACDA AS1 LR Irr 1
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8053741
|
|
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
|
|
|
E4527 Aph RBC ACDA AS1 LR Irr 1
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8053741
|
|
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
|
|
|
E4528 Aph RBC ACDA AS1 LR Irr 2
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8053742
|
|
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
|
|
|
E4528 Aph RBC ACDA AS1 LR Irr 2
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8053742
|
|
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
|
|
|
E4531 Aph RBC ACDA AS1 LR
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8053736
|
|
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
|
|
|
E4531 Aph RBC ACDA AS1 LR
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8053736
|
|
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
|
|
|
E4532 Aph RBC ACDA AS1 LR 1
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8053738
|
|
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
|
|
|
E4532 Aph RBC ACDA AS1 LR 1
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8053738
|
|
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
|
|
|
E4533 Aph RBC ACDA AS1 LR 2
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8053740
|
|
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
|
|
|
E4533 Aph RBC ACDA AS1 LR 2
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8053740
|
|
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
|
|
|
E4538 Aph RBC Trima AS3 LR Irr
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8018879
|
|
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
|
|
|
E4538 Aph RBC Trima AS3 LR Irr
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8018879
|
|
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
|
|
|
E4539 Aph RBC Trima AS3 LR Irr 1
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8018885
|
|
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
|
|
|
E4539 Aph RBC Trima AS3 LR Irr 1
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8018885
|
|
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
|
|
|
E4540 Aph RBC Trima AS3 LR Irr 2
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8018883
|
|
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
|
|
|
E4540 Aph RBC Trima AS3 LR Irr 2
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9040
|
| Hospital Charge Code |
8018883
|
|
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
|
|
|
E4543 Aph RBC Trima AS3 LR
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8018887
|
|
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
|
|
|
E4543 Aph RBC Trima AS3 LR
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8018887
|
|
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
|
|
|
E4544 Aph RBC Trima AS3 LR 1
|
Facility
|
OP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8018888
|
|
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
|
|
|
E4544 Aph RBC Trima AS3 LR 1
|
Facility
|
IP
|
$532.00
|
|
|
Service Code
|
HCPCS P9016
|
| Hospital Charge Code |
8018888
|
|
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
|
|
