|
E9232 Aph Plt ACDA LR BTD6
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758111
|
|
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
|
|
|
E9233 Aph Plt ACDA LR 1 BTD6
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758104
|
|
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
|
|
|
E9233 Aph Plt ACDA LR 1 BTD6
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758104
|
|
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
|
|
|
E9234 Aph Plt ACDA LR 2 BTD6
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758119
|
|
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
|
|
|
E9234 Aph Plt ACDA LR 2 BTD6
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758119
|
|
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
|
|
|
E9235 Aph Plt ACDA LR 3 BTD6
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758124
|
|
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
|
|
|
E9235 Aph Plt ACDA LR 3 BTD6
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758124
|
|
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
|
|
|
E9236 Aph Plt ACDA LR BTD7
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758114
|
|
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
|
|
|
E9236 Aph Plt ACDA LR BTD7
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758114
|
|
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
|
|
|
E9237 Aph Plt ACDA LR 1 BTD7
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758109
|
|
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
|
|
|
E9237 Aph Plt ACDA LR 1 BTD7
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758109
|
|
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
|
|
|
E9238 Aph Plt ACDA LR 2 BTD7
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758108
|
|
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
|
|
|
E9238 Aph Plt ACDA LR 2 BTD7
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758108
|
|
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
|
|
|
E9239 Aph Plt ACDA LR 3 BTD7
|
Facility
|
OP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758122
|
|
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
|
|
|
E9239 Aph Plt ACDA LR 3 BTD7
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
HCPCS P9035
|
| Hospital Charge Code |
8758122
|
|
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
|
|
|
E9252 Aph Plt ACDA LR Irr BTD5
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
8758127
|
|
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
|
|
|
E9252 Aph Plt ACDA LR Irr BTD5
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
8758127
|
|
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
|
|
|
E9253 Aph Plt ACDA LR Irr 1 BTD5
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
8758115
|
|
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
|
|
|
E9253 Aph Plt ACDA LR Irr 1 BTD5
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
8758115
|
|
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
|
|
|
E9254 Aph Plt ACDA LR Irr 2 BTD5
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
8758112
|
|
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
|
|
|
E9254 Aph Plt ACDA LR Irr 2 BTD5
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
8758112
|
|
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
|
|
|
E9255 Aph Plt ACDA LR Irr 3 BTD5
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
8758107
|
|
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
|
|
|
E9255 Aph Plt ACDA LR Irr 3 BTD5
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
8758107
|
|
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
|
|
|
E9256 Aph Plt ACDA LR Irr BTD6
|
Facility
|
OP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
8758120
|
|
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
|
|
|
E9256 Aph Plt ACDA LR Irr BTD6
|
Facility
|
IP
|
$881.00
|
|
|
Service Code
|
HCPCS P9037
|
| Hospital Charge Code |
8758120
|
|
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
|
|
