|
CHEMO IVF EA ADD'L SEQ INF
|
Facility
OP
|
$347.00
|
|
|
Service Code
|
CPT 96417
|
| Hospital Charge Code |
8378853
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$173.43 |
| Max. Negotiated Rate |
$610.39 |
| Rate for Payer: Aetna of IA Commercial |
$312.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$312.30
|
| Rate for Payer: Aetna of IA Medicare |
$197.79
|
| Rate for Payer: Amerigroup Medicaid |
$175.13
|
| Rate for Payer: Amerigroup Medicare |
$175.24
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$260.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$173.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$173.43
|
| Rate for Payer: Medical Associates Commercial |
$260.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$173.50
|
| Rate for Payer: Midlands Choice Commercial |
$242.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$176.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$260.25
|
| Rate for Payer: United Healthcare Commercial |
$312.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$204.73
|
| Rate for Payer: Wellmark IA HMO |
$554.90
|
| Rate for Payer: Wellmark IA PPO |
$610.39
|
|
|
CHEMO IVP
|
Facility
IP
|
$579.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
8378851
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$405.30 |
| Max. Negotiated Rate |
$521.10 |
| Rate for Payer: Aetna of IA Commercial |
$521.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$521.10
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$434.25
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
|
|
CHEMO IVP
|
Facility
OP
|
$579.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
8378851
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$289.38 |
| Max. Negotiated Rate |
$521.10 |
| Rate for Payer: Aetna of IA Commercial |
$521.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$521.10
|
| Rate for Payer: Aetna of IA Medicare |
$330.03
|
| Rate for Payer: Amerigroup Medicaid |
$292.22
|
| Rate for Payer: Amerigroup Medicare |
$292.40
|
| Rate for Payer: Cash Price |
$463.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$434.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$289.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$289.38
|
| Rate for Payer: Medical Associates Commercial |
$434.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$289.50
|
| Rate for Payer: Midlands Choice Commercial |
$405.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$293.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$434.25
|
| Rate for Payer: United Healthcare Commercial |
$521.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$341.61
|
|
|
Chemotherapy With Acute Leukemia as Secondary Diagnosis or With High Dose Chemotherapy Agent With MCC
|
Facility
IP
|
$30,263.46
|
|
|
Service Code
|
MS-DRG 837
|
| Hospital Charge Code |
579
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$30,263.46 |
| Rate for Payer: Amerigroup Medicaid |
$30,117.26
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29,824.86
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30,263.46
|
|
|
Chemotherapy With Acute Leukemia as Secondary Diagnosis With CC or High Dose Chemotherapy Agent
|
Facility
IP
|
$12,005.78
|
|
|
Service Code
|
MS-DRG 838
|
| Hospital Charge Code |
580
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,005.78 |
| Rate for Payer: Amerigroup Medicaid |
$11,947.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11,831.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,005.78
|
|
|
Chemotherapy With Acute Leukemia as Secondary Diagnosis Without CC/MCC
|
Facility
IP
|
$9,198.72
|
|
|
Service Code
|
MS-DRG 839
|
| Hospital Charge Code |
581
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,198.72 |
| Rate for Payer: Amerigroup Medicaid |
$9,154.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,065.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,198.72
|
|
|
Chemotherapy Without Acute Leukemia as Secondary Diagnosis With CC
|
Facility
IP
|
$10,829.61
|
|
|
Service Code
|
MS-DRG 847
|
| Hospital Charge Code |
589
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,829.61 |
| Rate for Payer: Amerigroup Medicaid |
$10,777.29
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,672.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,829.61
|
|
|
Chemotherapy Without Acute Leukemia as Secondary Diagnosis With MCC
|
Facility
IP
|
$10,956.57
|
|
|
Service Code
|
MS-DRG 846
|
| Hospital Charge Code |
588
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,956.57 |
| Rate for Payer: Amerigroup Medicaid |
$10,903.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,797.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,956.57
|
|
|
Chemotherapy Without Acute Leukemia as Secondary Diagnosis Without CC/MCC
|
Facility
IP
|
$9,003.84
|
|
|
Service Code
|
MS-DRG 848
|
| Hospital Charge Code |
590
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,003.84 |
| Rate for Payer: Amerigroup Medicaid |
$8,960.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,873.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,003.84
|
|
|
Chest Pain
|
Facility
IP
|
$5,031.45
|
|
|
Service Code
|
MS-DRG 313
|
| Hospital Charge Code |
170
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,031.45 |
| Rate for Payer: Amerigroup Medicaid |
$5,007.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4,958.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,031.45
|
|
|
CHEST PHYSIOTHERAPY, SUBSQ
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4770828
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
|
|
CHEST PHYSIOTHERAPY, SUBSQ
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 94668
|
| Hospital Charge Code |
4770828
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$54.48 |
| Max. Negotiated Rate |
$360.78 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Aetna of IA Medicare |
$62.13
|
| Rate for Payer: Amerigroup Medicaid |
$55.01
|
| Rate for Payer: Amerigroup Medicare |
$55.04
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.48
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.50
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.75
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
| Rate for Payer: Wellmark IA HMO |
$327.98
|
| Rate for Payer: Wellmark IA PPO |
$360.78
|
|
|
CHEST PHYSIOTHERPY INTIAL
|
Facility
OP
|
$154.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4770827
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$76.97 |
| Max. Negotiated Rate |
$360.78 |
| Rate for Payer: Aetna of IA Commercial |
$138.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$138.60
|
| Rate for Payer: Aetna of IA Medicare |
$87.78
|
| Rate for Payer: Amerigroup Medicaid |
$77.72
|
| Rate for Payer: Amerigroup Medicare |
$77.77
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$77.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.97
|
| Rate for Payer: Medical Associates Commercial |
$115.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$77.00
|
| Rate for Payer: Midlands Choice Commercial |
$107.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$78.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$138.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$90.86
|
| Rate for Payer: Wellmark IA HMO |
$327.98
|
| Rate for Payer: Wellmark IA PPO |
$360.78
|
|
|
CHEST PHYSIOTHERPY INTIAL
|
Facility
IP
|
$154.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
4770827
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$138.60 |
| Rate for Payer: Aetna of IA Commercial |
$138.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$138.60
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.50
|
| Rate for Payer: Medical Associates Commercial |
$115.50
|
| Rate for Payer: Midlands Choice Commercial |
$107.80
|
| Rate for Payer: United Healthcare Commercial |
$138.60
|
|
|
CHEST TUBE INSERTION ER CHARGE
|
Professional
|
$595.00
|
|
| Hospital Charge Code |
8069016
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$75.00 |
| Max. Negotiated Rate |
$416.50 |
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Cash Price |
$476.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$416.50
|
|
|
Chimeric Antigen Receptor (car) T-cell Immunotherapy
|
Facility
IP
|
$367,502.00
|
|
|
Service Code
|
MS-DRG 018
|
| Hospital Charge Code |
707
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$367,502.00 |
| Rate for Payer: Amerigroup Medicaid |
$365,726.63
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$362,175.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$367,502.00
|
|
|
chlordiazePOXIDE 25 mg Cap
|
Facility
OP
|
$3.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna of IA Commercial |
$3.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.17
|
| Rate for Payer: Aetna of IA Medicare |
$2.01
|
| Rate for Payer: Amerigroup Medicaid |
$1.78
|
| Rate for Payer: Amerigroup Medicare |
$1.78
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.76
|
| Rate for Payer: Medical Associates Commercial |
$2.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.76
|
| Rate for Payer: Midlands Choice Commercial |
$2.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.64
|
| Rate for Payer: United Healthcare Commercial |
$3.17
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.08
|
|
|
chlordiazePOXIDE 25 mg Cap
|
Facility
IP
|
$3.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702356
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$3.17 |
| Rate for Payer: Aetna of IA Commercial |
$3.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.17
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.64
|
| Rate for Payer: Medical Associates Commercial |
$2.64
|
| Rate for Payer: Midlands Choice Commercial |
$2.46
|
| Rate for Payer: United Healthcare Commercial |
$3.17
|
|
|
chlordiazePOXIDE 5 mg Cap
|
Facility
OP
|
$3.70
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna of IA Commercial |
$3.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.33
|
| Rate for Payer: Aetna of IA Medicare |
$2.11
|
| Rate for Payer: Amerigroup Medicaid |
$1.87
|
| Rate for Payer: Amerigroup Medicare |
$1.87
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.85
|
| Rate for Payer: Medical Associates Commercial |
$2.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.85
|
| Rate for Payer: Midlands Choice Commercial |
$2.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.78
|
| Rate for Payer: United Healthcare Commercial |
$3.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.18
|
|
|
chlordiazePOXIDE 5 mg Cap
|
Facility
IP
|
$3.70
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$3.33 |
| Rate for Payer: Aetna of IA Commercial |
$3.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.33
|
| Rate for Payer: Cash Price |
$2.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.78
|
| Rate for Payer: Medical Associates Commercial |
$2.78
|
| Rate for Payer: Midlands Choice Commercial |
$2.59
|
| Rate for Payer: United Healthcare Commercial |
$3.33
|
|
|
chlorhexidine gluconate 0.12% Liq 15 mL
|
Facility
IP
|
$6.31
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43758121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna of IA Commercial |
$5.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.68
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.73
|
| Rate for Payer: Medical Associates Commercial |
$4.73
|
| Rate for Payer: Midlands Choice Commercial |
$4.42
|
| Rate for Payer: United Healthcare Commercial |
$5.68
|
|
|
chlorhexidine gluconate 0.12% Liq 15 mL
|
Facility
OP
|
$6.31
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43758121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna of IA Commercial |
$5.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.68
|
| Rate for Payer: Aetna of IA Medicare |
$3.60
|
| Rate for Payer: Amerigroup Medicaid |
$3.18
|
| Rate for Payer: Amerigroup Medicare |
$3.19
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.15
|
| Rate for Payer: Medical Associates Commercial |
$4.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.16
|
| Rate for Payer: Midlands Choice Commercial |
$4.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.73
|
| Rate for Payer: United Healthcare Commercial |
$5.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.72
|
|
|
chlorhexidine topical
|
Facility
IP
|
$23.44
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$21.10 |
| Rate for Payer: Aetna of IA Commercial |
$21.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.10
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.58
|
| Rate for Payer: Medical Associates Commercial |
$17.58
|
| Rate for Payer: Midlands Choice Commercial |
$16.41
|
| Rate for Payer: United Healthcare Commercial |
$21.10
|
|
|
chlorhexidine topical
|
Facility
OP
|
$23.44
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700412
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$21.10 |
| Rate for Payer: Aetna of IA Commercial |
$21.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.10
|
| Rate for Payer: Aetna of IA Medicare |
$13.36
|
| Rate for Payer: Amerigroup Medicaid |
$11.83
|
| Rate for Payer: Amerigroup Medicare |
$11.84
|
| Rate for Payer: Cash Price |
$18.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.58
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.72
|
| Rate for Payer: Medical Associates Commercial |
$17.58
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.72
|
| Rate for Payer: Midlands Choice Commercial |
$16.41
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.58
|
| Rate for Payer: United Healthcare Commercial |
$21.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.83
|
|
|
CHLORIDE LEVEL
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
633621
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
|
