|
PT EVALUATION
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
5516782
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Aetna of IA Medicare |
$86.07
|
| Rate for Payer: Amerigroup Medicaid |
$87.10
|
| Rate for Payer: Amerigroup Medicare |
$68.63
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$86.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.95
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$87.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.14
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$89.09
|
|
|
PT EVALUATION
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
5516782
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$105.70 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Aetna of IA Commercial |
$135.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$135.90
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$113.25
|
| Rate for Payer: Medical Associates Commercial |
$113.25
|
| Rate for Payer: Midlands Choice Commercial |
$105.70
|
| Rate for Payer: United Healthcare Commercial |
$135.90
|
|
|
PT/INR
|
Facility
|
OP
|
$43.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1635510
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of IA Commercial |
$38.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.70
|
| Rate for Payer: Aetna of IA Medicare |
$24.51
|
| Rate for Payer: Amerigroup Medicaid |
$24.80
|
| Rate for Payer: Amerigroup Medicare |
$19.54
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$19.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24.56
|
| Rate for Payer: Medical Associates Commercial |
$32.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$19.35
|
| Rate for Payer: Midlands Choice Commercial |
$30.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.25
|
| Rate for Payer: United Healthcare Commercial |
$38.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.37
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
PT/INR
|
Facility
|
IP
|
$43.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1635510
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$30.10 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna of IA Commercial |
$38.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$38.70
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$32.25
|
| Rate for Payer: Medical Associates Commercial |
$32.25
|
| Rate for Payer: Midlands Choice Commercial |
$30.10
|
| Rate for Payer: United Healthcare Commercial |
$38.70
|
|
|
PTNM NEUROELTRD STIM POST TIBIAL
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
8588846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$296.55 |
| Max. Negotiated Rate |
$839.58 |
| Rate for Payer: Aetna of IA Commercial |
$593.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$593.10
|
| Rate for Payer: Aetna of IA Medicare |
$375.63
|
| Rate for Payer: Amerigroup Medicaid |
$380.11
|
| Rate for Payer: Amerigroup Medicare |
$299.52
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$494.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$296.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$376.42
|
| Rate for Payer: Medical Associates Commercial |
$494.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$296.55
|
| Rate for Payer: Midlands Choice Commercial |
$461.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$381.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$341.03
|
| Rate for Payer: United Healthcare Commercial |
$593.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$388.81
|
| Rate for Payer: Wellmark IA HMO WHPI |
$762.18
|
| Rate for Payer: Wellmark IA PPO |
$839.58
|
|
|
PTNM NEUROELTRD STIM POST TIBIAL
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT 64566
|
| Hospital Charge Code |
8588846
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$461.30 |
| Max. Negotiated Rate |
$593.10 |
| Rate for Payer: Aetna of IA Commercial |
$593.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$593.10
|
| Rate for Payer: Cash Price |
$527.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$494.25
|
| Rate for Payer: Medical Associates Commercial |
$494.25
|
| Rate for Payer: Midlands Choice Commercial |
$461.30
|
| Rate for Payer: United Healthcare Commercial |
$593.10
|
|
|
PT RE-EVAL EST PLAN CARE
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
8397249
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$61.65 |
| Max. Negotiated Rate |
$244.45 |
| Rate for Payer: Aetna of IA Commercial |
$123.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$123.30
|
| Rate for Payer: Aetna of IA Medicare |
$78.09
|
| Rate for Payer: Amerigroup Medicaid |
$79.02
|
| Rate for Payer: Amerigroup Medicare |
$62.27
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.25
|
| Rate for Payer: Medical Associates Commercial |
$102.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.65
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$70.90
|
| Rate for Payer: United Healthcare Commercial |
$123.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$80.83
|
| Rate for Payer: Wellmark IA HMO WHPI |
$221.92
|
| Rate for Payer: Wellmark IA PPO |
$244.45
|
|
|
PT RE-EVAL EST PLAN CARE
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 97164 GP
|
| Hospital Charge Code |
8397249
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of IA Commercial |
$123.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$123.30
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.75
|
| Rate for Payer: Medical Associates Commercial |
$102.75
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: United Healthcare Commercial |
$123.30
|
|
|
PT RE-EVALUATION
|
Facility
|
IP
|
$92.00
|
|
| Hospital Charge Code |
5520784
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of IA Commercial |
$82.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$82.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.00
|
| Rate for Payer: Medical Associates Commercial |
$69.00
|
| Rate for Payer: Midlands Choice Commercial |
$64.40
|
| Rate for Payer: United Healthcare Commercial |
$82.80
|
|
|
PT RE-EVALUATION
|
Facility
|
OP
|
$92.00
|
|
| Hospital Charge Code |
5520784
|
|
Hospital Revenue Code
|
424
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna of IA Commercial |
$82.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$82.80
|
| Rate for Payer: Aetna of IA Medicare |
$52.44
|
| Rate for Payer: Amerigroup Medicaid |
$53.07
|
| Rate for Payer: Amerigroup Medicare |
$41.81
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$69.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$52.55
|
| Rate for Payer: Medical Associates Commercial |
$69.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.40
|
| Rate for Payer: Midlands Choice Commercial |
$64.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$53.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.61
|
| Rate for Payer: United Healthcare Commercial |
$82.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$54.28
|
|
|
PTT
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$36.92
|
| Rate for Payer: Amerigroup Medicare |
$29.09
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.56
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.80
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
PTT
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
PTT SUBSTITUTION, PLASMA FRACTIONS
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
8093944
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
PTT SUBSTITUTION, PLASMA FRACTIONS
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
8093944
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$36.92
|
| Rate for Payer: Amerigroup Medicare |
$29.09
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.56
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.80
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
|
PT Unattended E-Stim Units
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
HCPCS G0283 GP
|
| Hospital Charge Code |
1374022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
|
|
PT Unattended E-Stim Units
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
HCPCS G0283 GP
|
| Hospital Charge Code |
1374022
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$81.22 |
| Rate for Payer: Aetna of IA Commercial |
$76.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.50
|
| Rate for Payer: Aetna of IA Medicare |
$48.45
|
| Rate for Payer: Amerigroup Medicaid |
$49.03
|
| Rate for Payer: Amerigroup Medicare |
$38.63
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.55
|
| Rate for Payer: Medical Associates Commercial |
$63.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.25
|
| Rate for Payer: Midlands Choice Commercial |
$59.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.99
|
| Rate for Payer: United Healthcare Commercial |
$76.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.15
|
| Rate for Payer: Wellmark IA HMO WHPI |
$73.74
|
| Rate for Payer: Wellmark IA PPO |
$81.22
|
|
|
PULM FUNCTION TEST VOLUMES BY GAS
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
5338938
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Aetna of IA Medicare |
$148.20
|
| Rate for Payer: Amerigroup Medicaid |
$149.97
|
| Rate for Payer: Amerigroup Medicare |
$118.17
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$117.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$148.51
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$150.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$134.55
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$153.40
|
| Rate for Payer: Wellmark IA HMO WHPI |
$185.05
|
| Rate for Payer: Wellmark IA PPO |
$203.84
|
|
|
PULM FUNCTION TEST VOLUMES BY GAS
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 94727
|
| Hospital Charge Code |
5338938
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$234.00 |
| Rate for Payer: Aetna of IA Commercial |
$234.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$234.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.00
|
| Rate for Payer: Medical Associates Commercial |
$195.00
|
| Rate for Payer: Midlands Choice Commercial |
$182.00
|
| Rate for Payer: United Healthcare Commercial |
$234.00
|
|
|
PULMONARY EDEMA AND RESPIRATORY FAILURE
|
Facility
|
IP
|
$12,429.66
|
|
|
Service Code
|
MSDRG 189
|
| Min. Negotiated Rate |
$12,249.51 |
| Max. Negotiated Rate |
$12,429.66 |
| Rate for Payer: Amerigroup Medicaid |
$12,369.61
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,249.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,429.66
|
|
|
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
|
IP
|
$13,490.33
|
|
|
Service Code
|
MSDRG 175
|
| Min. Negotiated Rate |
$13,294.81 |
| Max. Negotiated Rate |
$13,490.33 |
| Rate for Payer: Amerigroup Medicaid |
$13,425.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,294.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,490.33
|
|
|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$8,612.60
|
|
|
Service Code
|
MSDRG 176
|
| Min. Negotiated Rate |
$8,487.77 |
| Max. Negotiated Rate |
$8,612.60 |
| Rate for Payer: Amerigroup Medicaid |
$8,570.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,487.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,612.60
|
|
|
Pulmonary Rehab Non COPD Charge
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
8059084
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$185.88 |
| Rate for Payer: Aetna of IA Commercial |
$140.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.40
|
| Rate for Payer: Aetna of IA Medicare |
$88.92
|
| Rate for Payer: Amerigroup Medicaid |
$89.98
|
| Rate for Payer: Amerigroup Medicare |
$70.90
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.11
|
| Rate for Payer: Medical Associates Commercial |
$117.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.20
|
| Rate for Payer: Midlands Choice Commercial |
$109.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.73
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.04
|
| Rate for Payer: Wellmark IA HMO WHPI |
$168.74
|
| Rate for Payer: Wellmark IA PPO |
$185.88
|
|
|
Pulmonary Rehab Non COPD Charge
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS G0239 KX
|
| Hospital Charge Code |
8059083
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$185.88 |
| Rate for Payer: Aetna of IA Commercial |
$140.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.40
|
| Rate for Payer: Aetna of IA Medicare |
$88.92
|
| Rate for Payer: Amerigroup Medicaid |
$89.98
|
| Rate for Payer: Amerigroup Medicare |
$70.90
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.11
|
| Rate for Payer: Medical Associates Commercial |
$117.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.20
|
| Rate for Payer: Midlands Choice Commercial |
$109.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.73
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.04
|
| Rate for Payer: Wellmark IA HMO WHPI |
$168.74
|
| Rate for Payer: Wellmark IA PPO |
$185.88
|
|
|
Pulmonary Rehab Non COPD Charge
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
8059081
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$185.88 |
| Rate for Payer: Aetna of IA Commercial |
$140.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.40
|
| Rate for Payer: Aetna of IA Medicare |
$88.92
|
| Rate for Payer: Amerigroup Medicaid |
$89.98
|
| Rate for Payer: Amerigroup Medicare |
$70.90
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.11
|
| Rate for Payer: Medical Associates Commercial |
$117.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.20
|
| Rate for Payer: Midlands Choice Commercial |
$109.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.73
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.04
|
| Rate for Payer: Wellmark IA HMO WHPI |
$168.74
|
| Rate for Payer: Wellmark IA PPO |
$185.88
|
|
|
Pulmonary Rehab Non COPD Charge
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
8059084
|
|
Hospital Revenue Code
|
948
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Aetna of IA Commercial |
$140.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.40
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.00
|
| Rate for Payer: Medical Associates Commercial |
$117.00
|
| Rate for Payer: Midlands Choice Commercial |
$109.20
|
| Rate for Payer: United Healthcare Commercial |
$140.40
|
|
