|
INF TX MED EA ADDL HOUR
|
Facility
IP
|
$161.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
6922796
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
INF TX MED EA ADDL HOUR
|
Facility
OP
|
$161.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
4866842
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$609.03 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$81.26
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.47
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.50
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
| Rate for Payer: Wellmark IA HMO |
$553.66
|
| Rate for Payer: Wellmark IA PPO |
$609.03
|
|
|
INF TX MED EA ADDL HOUR
|
Facility
IP
|
$161.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
4866842
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
INF TX MED EA ADDL HOUR
|
Facility
OP
|
$161.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
6922796
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$609.03 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$81.26
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.47
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.50
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
| Rate for Payer: Wellmark IA HMO |
$553.66
|
| Rate for Payer: Wellmark IA PPO |
$609.03
|
|
|
INF TX MED SCHED 1ST HR
|
Facility
IP
|
$382.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
8012937
|
|
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 SCHED 1ST HR
|
Facility
OP
|
$382.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
8012937
|
|
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
|
|
|
INFUSAPORT DRAW FOR LAB
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
7796499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$12.99 |
| Max. Negotiated Rate |
$387.38 |
| Rate for Payer: Aetna of IA Commercial |
$23.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.40
|
| Rate for Payer: Aetna of IA Medicare |
$14.82
|
| Rate for Payer: Amerigroup Medicaid |
$13.12
|
| Rate for Payer: Amerigroup Medicare |
$13.13
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.99
|
| Rate for Payer: Medical Associates Commercial |
$19.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.00
|
| Rate for Payer: Midlands Choice Commercial |
$18.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.50
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.34
|
| Rate for Payer: Wellmark IA HMO |
$352.16
|
| Rate for Payer: Wellmark IA PPO |
$387.38
|
|
|
INFUSAPORT DRAW FOR LAB
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 36591
|
| Hospital Charge Code |
7796499
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna of IA Commercial |
$23.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.50
|
| Rate for Payer: Medical Associates Commercial |
$19.50
|
| Rate for Payer: Midlands Choice Commercial |
$18.20
|
| Rate for Payer: United Healthcare Commercial |
$23.40
|
|
|
INFUSAPORT REMOVAL ER CHARGE
|
Professional
|
$465.00
|
|
| Hospital Charge Code |
8068985
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$325.50
|
|
|
INFUSION TX CONCURRENT
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
7984744
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Aetna of IA Medicare |
$32.49
|
| Rate for Payer: Amerigroup Medicaid |
$28.77
|
| Rate for Payer: Amerigroup Medicare |
$28.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.49
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.50
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.75
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.63
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
INFUSION TX CONCURRENT
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
7984744
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
INFUSION TX EA SEQUENTIAL INF
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
7984743
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
|
|
INFUSION TX EA SEQUENTIAL INF
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
7984743
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$114.95 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$131.10
|
| Rate for Payer: Amerigroup Medicaid |
$116.08
|
| Rate for Payer: Amerigroup Medicare |
$116.15
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$115.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.95
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$115.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$116.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.50
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$135.70
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
INFUSION TX HYDRATION 1ST HR
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
7984739
|
|
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
|
|
|
INFUSION TX HYDRATION 1ST HR
|
Facility
IP
|
$344.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
7984739
|
|
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
|
|
|
INFUSION TX HYDRATION EA AD HR
|
Facility
OP
|
$152.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
7984740
|
|
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
|
|
|
INFUSION TX HYDRATION EA AD HR
|
Facility
IP
|
$152.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
7984740
|
|
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
|
|
|
INFUSION TX MED ADMIN 1ST HR
|
Facility
OP
|
$382.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
7984741
|
|
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
|
|
|
INFUSION TX MED ADMIN 1ST HR
|
Facility
IP
|
$382.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
7984741
|
|
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
|
|
|
INFUSION TX MED EA ADDL HOUR
|
Facility
OP
|
$161.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
7984742
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$80.47 |
| Max. Negotiated Rate |
$609.03 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$81.26
|
| Rate for Payer: Amerigroup Medicare |
$81.30
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.47
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.50
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.71
|
| Rate for Payer: Partners Health Alliance Commercial |
$120.75
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
| Rate for Payer: Wellmark IA HMO |
$553.66
|
| Rate for Payer: Wellmark IA PPO |
$609.03
|
|
|
INFUSION TX MED EA ADDL HOUR
|
Facility
IP
|
$161.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
7984742
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
INFUSION TX SEQENTIAL
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
4866841
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$114.95 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$131.10
|
| Rate for Payer: Amerigroup Medicaid |
$116.08
|
| Rate for Payer: Amerigroup Medicare |
$116.15
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$115.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.95
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$115.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$116.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.50
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$135.70
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
INFUSION TX SEQENTIAL
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
6922797
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
|
|
INFUSION TX SEQENTIAL
|
Facility
OP
|
$230.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
6922797
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$114.95 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$131.10
|
| Rate for Payer: Amerigroup Medicaid |
$116.08
|
| Rate for Payer: Amerigroup Medicare |
$116.15
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$115.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.95
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$115.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$116.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.50
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$135.70
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
INFUSION TX SEQENTIAL
|
Facility
IP
|
$230.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
4866841
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
|
