|
INFLUENZA AB
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
4110785
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Aetna of IA Medicare |
$46.74
|
| Rate for Payer: Amerigroup Medicaid |
$41.39
|
| Rate for Payer: Amerigroup Medicare |
$41.41
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.98
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.00
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.50
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.38
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
influenza QUAD Syringe virus vaccine, inactivated preservative-free quadrivalent Sus
|
Facility
IP
|
$31.30
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
43701162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.91 |
| Max. Negotiated Rate |
$28.17 |
| Rate for Payer: Aetna of IA Commercial |
$28.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.17
|
| Rate for Payer: Cash Price |
$25.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.48
|
| Rate for Payer: Medical Associates Commercial |
$23.48
|
| Rate for Payer: Midlands Choice Commercial |
$21.91
|
| Rate for Payer: United Healthcare Commercial |
$28.17
|
|
|
influenza QUAD Syringe virus vaccine, inactivated preservative-free quadrivalent Sus
|
Facility
OP
|
$31.30
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
43701162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$68.20 |
| Rate for Payer: Aetna of IA Commercial |
$28.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$28.17
|
| Rate for Payer: Aetna of IA Medicare |
$17.84
|
| Rate for Payer: Amerigroup Medicaid |
$15.80
|
| Rate for Payer: Amerigroup Medicare |
$15.81
|
| Rate for Payer: Cash Price |
$25.04
|
| Rate for Payer: Cash Price |
$25.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$23.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.64
|
| Rate for Payer: Medical Associates Commercial |
$23.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.65
|
| Rate for Payer: Midlands Choice Commercial |
$21.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.48
|
| Rate for Payer: United Healthcare Commercial |
$28.17
|
| Rate for Payer: United Healthcare Managed Medicare |
$18.47
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
|
influenza virus vaccine, inactivated 65+
|
Facility
IP
|
$103.92
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
43739390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.74 |
| Max. Negotiated Rate |
$93.53 |
| Rate for Payer: Aetna of IA Commercial |
$93.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.53
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.94
|
| Rate for Payer: Medical Associates Commercial |
$77.94
|
| Rate for Payer: Midlands Choice Commercial |
$72.74
|
| Rate for Payer: United Healthcare Commercial |
$93.53
|
|
|
influenza virus vaccine, inactivated 65+
|
Facility
OP
|
$103.92
|
|
|
Service Code
|
CPT 90694
|
| Hospital Charge Code |
43739390
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$93.53 |
| Rate for Payer: Aetna of IA Commercial |
$93.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.53
|
| Rate for Payer: Aetna of IA Medicare |
$59.23
|
| Rate for Payer: Amerigroup Medicaid |
$52.45
|
| Rate for Payer: Amerigroup Medicare |
$52.48
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.94
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.94
|
| Rate for Payer: Medical Associates Commercial |
$77.94
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.96
|
| Rate for Payer: Midlands Choice Commercial |
$72.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.94
|
| Rate for Payer: United Healthcare Commercial |
$93.53
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.31
|
| Rate for Payer: Wellmark IA HMO |
$62.00
|
| Rate for Payer: Wellmark IA PPO |
$68.20
|
|
|
INF TX-CONCURRENT
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
6922818
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Aetna of IA Medicare |
$58.71
|
| Rate for Payer: Amerigroup Medicaid |
$51.98
|
| Rate for Payer: Amerigroup Medicare |
$52.02
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.48
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.50
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.25
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.77
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
INF TX-CONCURRENT
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
4866839
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$51.48 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Aetna of IA Medicare |
$58.71
|
| Rate for Payer: Amerigroup Medicaid |
$51.98
|
| Rate for Payer: Amerigroup Medicare |
$52.02
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.48
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.50
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.25
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.77
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
INF TX-CONCURRENT
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
6922818
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
|
|
INF TX-CONCURRENT
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
4866839
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
|
|
INF TX HYDRATION 1ST HR
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
4866847
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$171.93 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Aetna of IA Medicare |
$196.08
|
| Rate for Payer: Amerigroup Medicaid |
$173.62
|
| Rate for Payer: Amerigroup Medicare |
$173.72
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$172.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.93
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$172.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$174.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$258.00
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.96
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
INF TX HYDRATION 1ST HR
|
Facility
IP
|
$344.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
4866847
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
|
|
INF TX HYDRATION 1ST HR
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
6922793
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$171.93 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Aetna of IA Medicare |
$196.08
|
| Rate for Payer: Amerigroup Medicaid |
$173.62
|
| Rate for Payer: Amerigroup Medicare |
$173.72
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$172.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.93
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$172.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$174.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$258.00
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.96
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
INF TX HYDRATION 1ST HR
|
Facility
IP
|
$344.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
6922793
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
|
|
INF TX HYDRATION EA ADDL HR
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
6922794
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$75.97 |
| Max. Negotiated Rate |
$609.03 |
| Rate for Payer: Aetna of IA Commercial |
$136.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$136.80
|
| Rate for Payer: Aetna of IA Medicare |
$86.64
|
| Rate for Payer: Amerigroup Medicaid |
$76.71
|
| Rate for Payer: Amerigroup Medicare |
$76.76
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$76.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.97
|
| Rate for Payer: Medical Associates Commercial |
$114.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.00
|
| Rate for Payer: Midlands Choice Commercial |
$106.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.00
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.68
|
| Rate for Payer: Wellmark IA HMO |
$553.66
|
| Rate for Payer: Wellmark IA PPO |
$609.03
|
|
|
INF TX HYDRATION EA ADDL HR
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
6922794
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of IA Commercial |
$136.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$136.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.00
|
| Rate for Payer: Medical Associates Commercial |
$114.00
|
| Rate for Payer: Midlands Choice Commercial |
$106.40
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
|
|
INF TX HYDRATION EA ADDL HR
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
4866845
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of IA Commercial |
$136.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$136.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.00
|
| Rate for Payer: Medical Associates Commercial |
$114.00
|
| Rate for Payer: Midlands Choice Commercial |
$106.40
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
|
|
INF TX HYDRATION EA ADDL HR
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
4866845
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$75.97 |
| Max. Negotiated Rate |
$609.03 |
| Rate for Payer: Aetna of IA Commercial |
$136.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$136.80
|
| Rate for Payer: Aetna of IA Medicare |
$86.64
|
| Rate for Payer: Amerigroup Medicaid |
$76.71
|
| Rate for Payer: Amerigroup Medicare |
$76.76
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$76.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.97
|
| Rate for Payer: Medical Associates Commercial |
$114.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.00
|
| Rate for Payer: Midlands Choice Commercial |
$106.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.00
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.68
|
| Rate for Payer: Wellmark IA HMO |
$553.66
|
| Rate for Payer: Wellmark IA PPO |
$609.03
|
|
|
INF TX HYDRATION-SCHED 1ST HR
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
8012935
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$171.93 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Aetna of IA Medicare |
$196.08
|
| Rate for Payer: Amerigroup Medicaid |
$173.62
|
| Rate for Payer: Amerigroup Medicare |
$173.72
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$172.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$171.93
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$172.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$174.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$258.00
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$202.96
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
INF TX HYDRATION-SCHED 1ST HR
|
Facility
IP
|
$344.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
8012935
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$309.60 |
| Rate for Payer: Aetna of IA Commercial |
$309.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$309.60
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$258.00
|
| Rate for Payer: Medical Associates Commercial |
$258.00
|
| Rate for Payer: Midlands Choice Commercial |
$240.80
|
| Rate for Payer: United Healthcare Commercial |
$309.60
|
|
|
INF TX HYDR SCHED EA ADDL HR
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
8012936
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$106.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna of IA Commercial |
$136.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$136.80
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.00
|
| Rate for Payer: Medical Associates Commercial |
$114.00
|
| Rate for Payer: Midlands Choice Commercial |
$106.40
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
|
|
INF TX HYDR SCHED EA ADDL HR
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
8012936
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$75.97 |
| Max. Negotiated Rate |
$609.03 |
| Rate for Payer: Aetna of IA Commercial |
$136.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$136.80
|
| Rate for Payer: Aetna of IA Medicare |
$86.64
|
| Rate for Payer: Amerigroup Medicaid |
$76.71
|
| Rate for Payer: Amerigroup Medicare |
$76.76
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$76.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$75.97
|
| Rate for Payer: Medical Associates Commercial |
$114.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.00
|
| Rate for Payer: Midlands Choice Commercial |
$106.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.00
|
| Rate for Payer: United Healthcare Commercial |
$136.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.68
|
| Rate for Payer: Wellmark IA HMO |
$553.66
|
| Rate for Payer: Wellmark IA PPO |
$609.03
|
|
|
INF TX MED 1ST HR
|
Facility
OP
|
$382.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
6922795
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$190.92 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$343.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$343.80
|
| Rate for Payer: Aetna of IA Medicare |
$217.74
|
| Rate for Payer: Amerigroup Medicaid |
$192.80
|
| Rate for Payer: Amerigroup Medicare |
$192.91
|
| Rate for Payer: Cash Price |
$305.60
|
| Rate for Payer: Cash Price |
$305.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$286.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$191.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$190.92
|
| Rate for Payer: Medical Associates Commercial |
$286.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$191.00
|
| Rate for Payer: Midlands Choice Commercial |
$267.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$193.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$286.50
|
| Rate for Payer: United Healthcare Commercial |
$343.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$225.38
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
INF TX MED 1ST HR
|
Facility
IP
|
$382.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
4866843
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$267.40 |
| Max. Negotiated Rate |
$343.80 |
| Rate for Payer: Aetna of IA Commercial |
$343.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$343.80
|
| Rate for Payer: Cash Price |
$305.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$286.50
|
| Rate for Payer: Medical Associates Commercial |
$286.50
|
| Rate for Payer: Midlands Choice Commercial |
$267.40
|
| Rate for Payer: United Healthcare Commercial |
$343.80
|
|
|
INF TX MED 1ST HR
|
Facility
OP
|
$382.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
4866843
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$190.92 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$343.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$343.80
|
| Rate for Payer: Aetna of IA Medicare |
$217.74
|
| Rate for Payer: Amerigroup Medicaid |
$192.80
|
| Rate for Payer: Amerigroup Medicare |
$192.91
|
| Rate for Payer: Cash Price |
$305.60
|
| Rate for Payer: Cash Price |
$305.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$286.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$191.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$190.92
|
| Rate for Payer: Medical Associates Commercial |
$286.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$191.00
|
| Rate for Payer: Midlands Choice Commercial |
$267.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$193.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$286.50
|
| Rate for Payer: United Healthcare Commercial |
$343.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$225.38
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
INF TX MED 1ST HR
|
Facility
IP
|
$382.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
6922795
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$267.40 |
| Max. Negotiated Rate |
$343.80 |
| Rate for Payer: Aetna of IA Commercial |
$343.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$343.80
|
| Rate for Payer: Cash Price |
$305.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$286.50
|
| Rate for Payer: Medical Associates Commercial |
$286.50
|
| Rate for Payer: Midlands Choice Commercial |
$267.40
|
| Rate for Payer: United Healthcare Commercial |
$343.80
|
|
