|
INTRAPLEURAL INSERTION CHARGE
|
Facility
|
OP
|
$213.00
|
|
| Hospital Charge Code |
8059077
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$191.70 |
| Rate for Payer: Aetna of IA Commercial |
$191.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$191.70
|
| Rate for Payer: Aetna of IA Medicare |
$121.41
|
| Rate for Payer: Amerigroup Medicaid |
$122.86
|
| Rate for Payer: Amerigroup Medicare |
$96.81
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$159.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$95.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$121.67
|
| Rate for Payer: Medical Associates Commercial |
$159.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$95.85
|
| Rate for Payer: Midlands Choice Commercial |
$149.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$123.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$110.23
|
| Rate for Payer: United Healthcare Commercial |
$191.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$125.67
|
|
|
INVASIVE BUNION PLATE LEFT
|
Facility
|
IP
|
$2,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8788813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,814.40 |
| Max. Negotiated Rate |
$2,332.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,332.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,332.80
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,944.00
|
| Rate for Payer: Medical Associates Commercial |
$1,944.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,814.40
|
| Rate for Payer: United Healthcare Commercial |
$2,332.80
|
|
|
INVASIVE BUNION PLATE LEFT
|
Facility
|
OP
|
$2,592.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8788813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.40 |
| Max. Negotiated Rate |
$2,332.80 |
| Rate for Payer: Aetna of IA Commercial |
$2,332.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,332.80
|
| Rate for Payer: Aetna of IA Medicare |
$1,477.44
|
| Rate for Payer: Amerigroup Medicaid |
$1,495.07
|
| Rate for Payer: Amerigroup Medicare |
$1,178.06
|
| Rate for Payer: Cash Price |
$2,073.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,944.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,166.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,480.55
|
| Rate for Payer: Medical Associates Commercial |
$1,944.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,166.40
|
| Rate for Payer: Midlands Choice Commercial |
$1,814.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,502.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,341.36
|
| Rate for Payer: United Healthcare Commercial |
$2,332.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,529.28
|
|
|
iohexol 300 mg/mL Sol[VDMC]
|
Facility
|
IP
|
$172.38
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
23686528
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$155.14 |
| Rate for Payer: Aetna of IA Commercial |
$155.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$155.14
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$129.28
|
| Rate for Payer: Medical Associates Commercial |
$129.28
|
| Rate for Payer: Midlands Choice Commercial |
$120.67
|
| Rate for Payer: United Healthcare Commercial |
$155.14
|
|
|
iohexol 300 mg/mL Sol[VDMC]
|
Facility
|
OP
|
$172.38
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
23686528
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$77.57 |
| Max. Negotiated Rate |
$155.14 |
| Rate for Payer: Aetna of IA Commercial |
$155.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$155.14
|
| Rate for Payer: Aetna of IA Medicare |
$98.26
|
| Rate for Payer: Amerigroup Medicaid |
$99.43
|
| Rate for Payer: Amerigroup Medicare |
$78.35
|
| Rate for Payer: Cash Price |
$137.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$129.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$77.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.46
|
| Rate for Payer: Medical Associates Commercial |
$129.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$77.57
|
| Rate for Payer: Midlands Choice Commercial |
$120.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$99.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$89.21
|
| Rate for Payer: United Healthcare Commercial |
$155.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$101.70
|
|
|
IONTOPHORESIS APPLICATION PER 15 MIN
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
1373909
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
|
|
IONTOPHORESIS APPLICATION PER 15 MIN
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 97033 GP
|
| Hospital Charge Code |
1373909
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.30 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Aetna of IA Medicare |
$76.38
|
| Rate for Payer: Amerigroup Medicaid |
$77.29
|
| Rate for Payer: Amerigroup Medicare |
$60.90
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$60.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.54
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.30
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.34
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.06
|
|
|
IONTOPHORESIS APPLICATION PER 15 MIN
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
1373443
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
|
|
IONTOPHORESIS APPLICATION PER 15 MIN
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
1373443
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.30 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Aetna of IA Commercial |
$120.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$120.60
|
| Rate for Payer: Aetna of IA Medicare |
$76.38
|
| Rate for Payer: Amerigroup Medicaid |
$77.29
|
| Rate for Payer: Amerigroup Medicare |
$60.90
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$100.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$60.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.54
|
| Rate for Payer: Medical Associates Commercial |
$100.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.30
|
| Rate for Payer: Midlands Choice Commercial |
$93.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.67
|
| Rate for Payer: Partners Health Alliance Commercial |
$69.34
|
| Rate for Payer: United Healthcare Commercial |
$120.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.06
|
|
|
IOP Activity Therapy
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS G0176
|
| Hospital Charge Code |
8300867
|
|
Hospital Revenue Code
|
904
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
|
|
IOP Activity Therapy
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS G0176
|
| Hospital Charge Code |
8300867
|
|
Hospital Revenue Code
|
904
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Aetna of IA Medicare |
$125.97
|
| Rate for Payer: Amerigroup Medicaid |
$127.47
|
| Rate for Payer: Amerigroup Medicare |
$100.44
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.24
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.45
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.37
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
|
|
iopamidol 41% Sol[VDMC]
|
Facility
|
OP
|
$57.58
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
12697970
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$51.82 |
| Rate for Payer: Aetna of IA Commercial |
$51.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.82
|
| Rate for Payer: Aetna of IA Medicare |
$32.82
|
| Rate for Payer: Amerigroup Medicaid |
$33.21
|
| Rate for Payer: Amerigroup Medicare |
$26.17
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.89
|
| Rate for Payer: Medical Associates Commercial |
$43.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.91
|
| Rate for Payer: Midlands Choice Commercial |
$40.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$29.80
|
| Rate for Payer: United Healthcare Commercial |
$51.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.97
|
|
|
iopamidol 41% Sol[VDMC]
|
Facility
|
IP
|
$57.58
|
|
|
Service Code
|
HCPCS Q9966
|
| Hospital Charge Code |
12697970
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.31 |
| Max. Negotiated Rate |
$51.82 |
| Rate for Payer: Aetna of IA Commercial |
$51.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.82
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.19
|
| Rate for Payer: Medical Associates Commercial |
$43.19
|
| Rate for Payer: Midlands Choice Commercial |
$40.31
|
| Rate for Payer: United Healthcare Commercial |
$51.82
|
|
|
IOP On-Site Group Therapy minimum 45 minutes
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
HCPCS G0410
|
| Hospital Charge Code |
8300862
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
|
|
IOP On-Site Group Therapy minimum 45 minutes
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
HCPCS G0410
|
| Hospital Charge Code |
8300862
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$99.45 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Aetna of IA Commercial |
$198.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.90
|
| Rate for Payer: Aetna of IA Medicare |
$125.97
|
| Rate for Payer: Amerigroup Medicaid |
$127.47
|
| Rate for Payer: Amerigroup Medicare |
$100.44
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.24
|
| Rate for Payer: Medical Associates Commercial |
$165.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.45
|
| Rate for Payer: Midlands Choice Commercial |
$154.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.37
|
| Rate for Payer: United Healthcare Commercial |
$198.90
|
|
|
IOP Psychotherapy - Family w/o Patient
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
8987983
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$79.65 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Aetna of IA Medicare |
$100.89
|
| Rate for Payer: Amerigroup Medicaid |
$102.09
|
| Rate for Payer: Amerigroup Medicare |
$80.45
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$101.10
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.65
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.60
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
|
|
IOP Psychotherapy - Family w/o Patient
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 90846
|
| Hospital Charge Code |
8987983
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
|
|
IOP Psychotherapy - Family w/ Patient
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
8987984
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$79.65 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Aetna of IA Medicare |
$100.89
|
| Rate for Payer: Amerigroup Medicaid |
$102.09
|
| Rate for Payer: Amerigroup Medicare |
$80.45
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$79.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$101.10
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$79.65
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$102.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$91.60
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
|
|
IOP Psychotherapy - Family w/ Patient
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 90847
|
| Hospital Charge Code |
8987984
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$123.90 |
| Max. Negotiated Rate |
$159.30 |
| Rate for Payer: Aetna of IA Commercial |
$159.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$159.30
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$132.75
|
| Rate for Payer: Medical Associates Commercial |
$132.75
|
| Rate for Payer: Midlands Choice Commercial |
$123.90
|
| Rate for Payer: United Healthcare Commercial |
$159.30
|
|
|
IOP Psychotherapy - Individual 16-37 min
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
8987980
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$126.70 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
|
|
IOP Psychotherapy - Individual 16-37 min
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 90832
|
| Hospital Charge Code |
8987980
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna of IA Commercial |
$162.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.90
|
| Rate for Payer: Aetna of IA Medicare |
$103.17
|
| Rate for Payer: Amerigroup Medicaid |
$104.40
|
| Rate for Payer: Amerigroup Medicare |
$82.26
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$103.39
|
| Rate for Payer: Medical Associates Commercial |
$135.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.45
|
| Rate for Payer: Midlands Choice Commercial |
$126.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$104.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$93.67
|
| Rate for Payer: United Healthcare Commercial |
$162.90
|
|
|
IOP Psychotherapy - Individual 38-57 min
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
8987981
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$163.35 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of IA Commercial |
$326.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$326.70
|
| Rate for Payer: Aetna of IA Medicare |
$206.91
|
| Rate for Payer: Amerigroup Medicaid |
$209.38
|
| Rate for Payer: Amerigroup Medicare |
$164.98
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$272.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$163.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$207.35
|
| Rate for Payer: Medical Associates Commercial |
$272.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$163.35
|
| Rate for Payer: Midlands Choice Commercial |
$254.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$210.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$187.85
|
| Rate for Payer: United Healthcare Commercial |
$326.70
|
|
|
IOP Psychotherapy - Individual 38-57 min
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 90834
|
| Hospital Charge Code |
8987981
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of IA Commercial |
$326.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$326.70
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$272.25
|
| Rate for Payer: Medical Associates Commercial |
$272.25
|
| Rate for Payer: Midlands Choice Commercial |
$254.10
|
| Rate for Payer: United Healthcare Commercial |
$326.70
|
|
|
IOP Psychotherapy - Individual 58 min or more
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
8987982
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$163.35 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of IA Commercial |
$326.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$326.70
|
| Rate for Payer: Aetna of IA Medicare |
$206.91
|
| Rate for Payer: Amerigroup Medicaid |
$209.38
|
| Rate for Payer: Amerigroup Medicare |
$164.98
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$272.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$163.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$207.35
|
| Rate for Payer: Medical Associates Commercial |
$272.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$163.35
|
| Rate for Payer: Midlands Choice Commercial |
$254.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$210.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$187.85
|
| Rate for Payer: United Healthcare Commercial |
$326.70
|
|
|
IOP Psychotherapy - Individual 58 min or more
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 90837
|
| Hospital Charge Code |
8987982
|
|
Hospital Revenue Code
|
914
|
| Min. Negotiated Rate |
$254.10 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Aetna of IA Commercial |
$326.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$326.70
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$272.25
|
| Rate for Payer: Medical Associates Commercial |
$272.25
|
| Rate for Payer: Midlands Choice Commercial |
$254.10
|
| Rate for Payer: United Healthcare Commercial |
$326.70
|
|
