|
Folate Level
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
8220859
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Folate Level DMCL
|
Facility
IP
|
$100.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
8037847
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
Folate Level DMCL
|
Facility
OP
|
$100.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
8037847
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
FOLEY CATH INSERTION
|
Professional
|
$169.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
7822796
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$118.30 |
| Rate for Payer: Aetna of IA Medicare |
$22.95
|
| Rate for Payer: Amerigroup Medicaid |
$23.73
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Cash Price |
$135.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$23.41
|
| Rate for Payer: Medical Associates Commercial |
$43.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.95
|
| Rate for Payer: Midlands Choice Commercial |
$118.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$34.42
|
| Rate for Payer: Wellmark IA HMO |
$47.00
|
| Rate for Payer: Wellmark IA PPO |
$55.00
|
|
|
FOLEY CATH SCHEDULED
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
8012933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$120.95 |
| Max. Negotiated Rate |
$403.74 |
| Rate for Payer: Aetna of IA Commercial |
$217.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$217.80
|
| Rate for Payer: Aetna of IA Medicare |
$137.94
|
| Rate for Payer: Amerigroup Medicaid |
$122.14
|
| Rate for Payer: Amerigroup Medicare |
$122.21
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$181.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$121.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$120.95
|
| Rate for Payer: Medical Associates Commercial |
$181.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$121.00
|
| Rate for Payer: Midlands Choice Commercial |
$169.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$122.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$181.50
|
| Rate for Payer: United Healthcare Commercial |
$217.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$142.78
|
| Rate for Payer: Wellmark IA HMO |
$367.04
|
| Rate for Payer: Wellmark IA PPO |
$403.74
|
|
|
FOLEY CATH SCHEDULED
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
8012933
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna of IA Commercial |
$217.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$217.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$181.50
|
| Rate for Payer: Medical Associates Commercial |
$181.50
|
| Rate for Payer: Midlands Choice Commercial |
$169.40
|
| Rate for Payer: United Healthcare Commercial |
$217.80
|
|
|
folic acid 1 mg Tab
|
Facility
OP
|
$1.66
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of IA Commercial |
$1.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.49
|
| Rate for Payer: Aetna of IA Medicare |
$0.95
|
| Rate for Payer: Amerigroup Medicaid |
$0.84
|
| Rate for Payer: Amerigroup Medicare |
$0.84
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$1.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.83
|
| Rate for Payer: Midlands Choice Commercial |
$1.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.24
|
| Rate for Payer: United Healthcare Commercial |
$1.49
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.98
|
|
|
folic acid 1 mg Tab
|
Facility
IP
|
$1.66
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of IA Commercial |
$1.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.49
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.24
|
| Rate for Payer: Medical Associates Commercial |
$1.24
|
| Rate for Payer: Midlands Choice Commercial |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.49
|
|
|
Follicle Stimulating Hormone DMCL
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
8037848
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
Follicle Stimulating Hormone DMCL
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
8037848
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Foot Procedures With CC
|
Facility
IP
|
$12,872.90
|
|
|
Service Code
|
MS-DRG 504
|
| Hospital Charge Code |
321
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,872.90 |
| Rate for Payer: Amerigroup Medicaid |
$12,810.71
|
| 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 |
$12,686.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,872.90
|
|
|
Foot Procedures With MCC
|
Facility
IP
|
$25,879.65
|
|
|
Service Code
|
MS-DRG 503
|
| Hospital Charge Code |
320
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$25,879.65 |
| Rate for Payer: Amerigroup Medicaid |
$25,754.62
|
| 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 |
$25,504.58
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25,879.65
|
|
|
Foot Procedures Without CC/MCC
|
Facility
IP
|
$12,491.99
|
|
|
Service Code
|
MS-DRG 505
|
| Hospital Charge Code |
322
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,491.99 |
| Rate for Payer: Amerigroup Medicaid |
$12,431.65
|
| 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 |
$12,310.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,491.99
|
|
|
FOREIGN BODY REMOVAL EAR
|
Professional
|
$210.00
|
|
|
Service Code
|
CPT 69200
|
| Hospital Charge Code |
7982760
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$43.00 |
| Max. Negotiated Rate |
$147.00 |
| Rate for Payer: Aetna of IA Medicare |
$43.00
|
| Rate for Payer: Amerigroup Medicaid |
$44.46
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.86
|
| Rate for Payer: Medical Associates Commercial |
$81.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.00
|
| Rate for Payer: Midlands Choice Commercial |
$147.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.50
|
| Rate for Payer: Wellmark IA HMO |
$90.00
|
| Rate for Payer: Wellmark IA PPO |
$105.00
|
|
|
FOREIGN BODY REMOVAL NOSE
|
Professional
|
$415.00
|
|
|
Service Code
|
CPT 30300
|
| Hospital Charge Code |
7982783
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$111.93 |
| Max. Negotiated Rate |
$290.50 |
| Rate for Payer: Aetna of IA Medicare |
$111.93
|
| Rate for Payer: Amerigroup Medicaid |
$115.74
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Cash Price |
$332.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$134.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.17
|
| Rate for Payer: Medical Associates Commercial |
$212.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$111.93
|
| Rate for Payer: Midlands Choice Commercial |
$290.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$167.90
|
| Rate for Payer: Wellmark IA HMO |
$239.00
|
| Rate for Payer: Wellmark IA PPO |
$280.00
|
|
|
FOREIGN BODY REMOVAL SIMPLE
|
Professional
|
$365.00
|
|
|
Service Code
|
CPT 10120
|
| Hospital Charge Code |
7982856
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$255.50 |
| Rate for Payer: Aetna of IA Medicare |
$96.60
|
| Rate for Payer: Amerigroup Medicaid |
$99.88
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.53
|
| Rate for Payer: Medical Associates Commercial |
$183.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$96.60
|
| Rate for Payer: Midlands Choice Commercial |
$255.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$144.90
|
| Rate for Payer: Wellmark IA HMO |
$200.00
|
| Rate for Payer: Wellmark IA PPO |
$235.00
|
|
|
fosaprepitant 150 mg Pow
|
Facility
IP
|
$1,154.72
|
|
|
Service Code
|
CPT J1453
|
| Hospital Charge Code |
43706689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$808.30 |
| Max. Negotiated Rate |
$1,039.25 |
| Rate for Payer: Aetna of IA Commercial |
$1,039.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,039.25
|
| Rate for Payer: Cash Price |
$923.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$866.04
|
| Rate for Payer: Medical Associates Commercial |
$866.04
|
| Rate for Payer: Midlands Choice Commercial |
$808.30
|
| Rate for Payer: United Healthcare Commercial |
$1,039.25
|
|
|
fosaprepitant 150 mg Pow
|
Facility
OP
|
$1,154.72
|
|
|
Service Code
|
CPT J1453
|
| Hospital Charge Code |
43706689
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$577.13 |
| Max. Negotiated Rate |
$1,039.25 |
| Rate for Payer: Aetna of IA Commercial |
$1,039.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,039.25
|
| Rate for Payer: Aetna of IA Medicare |
$658.19
|
| Rate for Payer: Amerigroup Medicaid |
$582.79
|
| Rate for Payer: Amerigroup Medicare |
$583.13
|
| Rate for Payer: Cash Price |
$923.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$866.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$577.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$577.13
|
| Rate for Payer: Medical Associates Commercial |
$866.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$577.36
|
| Rate for Payer: Midlands Choice Commercial |
$808.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$586.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$866.04
|
| Rate for Payer: United Healthcare Commercial |
$1,039.25
|
| Rate for Payer: United Healthcare Managed Medicare |
$681.28
|
|
|
fosinopril 10 mg Tab
|
Facility
OP
|
$1.42
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701784
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of IA Commercial |
$1.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.28
|
| Rate for Payer: Aetna of IA Medicare |
$0.81
|
| Rate for Payer: Amerigroup Medicaid |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.71
|
| Rate for Payer: Medical Associates Commercial |
$1.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.71
|
| Rate for Payer: Midlands Choice Commercial |
$0.99
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.84
|
|
|
fosinopril 10 mg Tab
|
Facility
IP
|
$1.42
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701784
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of IA Commercial |
$1.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.28
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.06
|
| Rate for Payer: Medical Associates Commercial |
$1.06
|
| Rate for Payer: Midlands Choice Commercial |
$0.99
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
|
|
Fractures of Femur With MCC
|
Facility
IP
|
$13,907.34
|
|
|
Service Code
|
MS-DRG 533
|
| Hospital Charge Code |
340
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,907.34 |
| Rate for Payer: Amerigroup Medicaid |
$13,840.15
|
| 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 |
$13,705.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,907.34
|
|
|
Fractures of Femur Without MCC
|
Facility
IP
|
$4,390.70
|
|
|
Service Code
|
MS-DRG 534
|
| Hospital Charge Code |
341
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$4,390.70 |
| Rate for Payer: Amerigroup Medicaid |
$4,369.49
|
| 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 |
$4,327.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,390.70
|
|
|
Fractures of Hip and Pelvis With MCC
|
Facility
IP
|
$9,672.14
|
|
|
Service Code
|
MS-DRG 535
|
| Hospital Charge Code |
342
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,672.14 |
| Rate for Payer: Amerigroup Medicaid |
$9,625.41
|
| 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 |
$9,531.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,672.14
|
|
|
Fractures of Hip and Pelvis Without MCC
|
Facility
IP
|
$7,944.79
|
|
|
Service Code
|
MS-DRG 536
|
| Hospital Charge Code |
343
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,944.79 |
| Rate for Payer: Amerigroup Medicaid |
$7,906.41
|
| 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 |
$7,829.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,944.79
|
|
|
Fracture, Sprain, Strain and Dislocation Except Femur, Hip, Pelvis and Thigh With MCC
|
Facility
IP
|
$8,837.50
|
|
|
Service Code
|
MS-DRG 562
|
| Hospital Charge Code |
369
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,837.50 |
| Rate for Payer: Amerigroup Medicaid |
$8,794.81
|
| 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 |
$8,709.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,837.50
|
|
