|
Hepatobiliary Diagnostic Procedures With MCC
|
Facility
|
IP
|
$34,596.09
|
|
|
Service Code
|
MS-DRG 420
|
| Hospital Charge Code |
252
|
| Min. Negotiated Rate |
$34,094.69 |
| Max. Negotiated Rate |
$34,596.09 |
| Rate for Payer: Amerigroup Medicaid |
$34,428.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34,094.69
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34,596.09
|
|
|
Hepatobiliary Diagnostic Procedures Without CC/MCC
|
Facility
|
IP
|
$10,157.38
|
|
|
Service Code
|
MS-DRG 422
|
| Hospital Charge Code |
254
|
| Min. Negotiated Rate |
$10,010.17 |
| Max. Negotiated Rate |
$10,157.38 |
| Rate for Payer: Amerigroup Medicaid |
$10,108.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,010.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,157.38
|
|
|
Hep B Sur Ab Quant DMCL
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
8037862
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of IA Commercial |
$79.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.20
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.00
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
|
|
Hep B Sur Ab Quant DMCL
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
8037862
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$43.98 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Aetna of IA Commercial |
$79.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$79.20
|
| Rate for Payer: Aetna of IA Medicare |
$50.16
|
| Rate for Payer: Amerigroup Medicaid |
$44.41
|
| Rate for Payer: Amerigroup Medicare |
$44.44
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$66.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.98
|
| Rate for Payer: Medical Associates Commercial |
$66.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.00
|
| Rate for Payer: Midlands Choice Commercial |
$61.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.66
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$44.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$66.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$66.00
|
| Rate for Payer: United Healthcare Commercial |
$79.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.92
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Hernia Procedures Except Inguinal and Femoral With CC
|
Facility
|
IP
|
$14,908.31
|
|
|
Service Code
|
MS-DRG 354
|
| Hospital Charge Code |
204
|
| Min. Negotiated Rate |
$14,692.24 |
| Max. Negotiated Rate |
$14,908.31 |
| Rate for Payer: Amerigroup Medicaid |
$14,836.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14,692.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,908.31
|
|
|
Hernia Procedures Except Inguinal and Femoral With MCC
|
Facility
|
IP
|
$19,824.60
|
|
|
Service Code
|
MS-DRG 353
|
| Hospital Charge Code |
203
|
| Min. Negotiated Rate |
$19,537.28 |
| Max. Negotiated Rate |
$19,824.60 |
| Rate for Payer: Amerigroup Medicaid |
$19,728.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19,537.28
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,824.60
|
|
|
Hernia Procedures Except Inguinal and Femoral Without CC/MCC
|
Facility
|
IP
|
$13,281.36
|
|
|
Service Code
|
MS-DRG 355
|
| Hospital Charge Code |
205
|
| Min. Negotiated Rate |
$13,088.87 |
| Max. Negotiated Rate |
$13,281.36 |
| Rate for Payer: Amerigroup Medicaid |
$13,217.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,088.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,281.36
|
|
|
Herpes Simplex PCR Qual DMCL
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037869
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
Herpes Simplex PCR Qual DMCL
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037869
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
Herpes Simplex PCR Qual Stat DMCL
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037870
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
Herpes Simplex PCR Qual Stat DMCL
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037870
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
Herpes Simplex Virus by PCR DMCL
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037872
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
Herpes Simplex Virus by PCR DMCL
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8037872
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
Herpes Simplex Virus IgM Antibody DMCL
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
8037873
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna of IA Commercial |
$106.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.20
|
| Rate for Payer: Aetna of IA Medicare |
$67.26
|
| Rate for Payer: Amerigroup Medicaid |
$59.55
|
| Rate for Payer: Amerigroup Medicare |
$59.59
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.98
|
| Rate for Payer: Medical Associates Commercial |
$88.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.00
|
| Rate for Payer: Midlands Choice Commercial |
$82.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.88
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$59.85
|
| Rate for Payer: Oscar Health of IA Commercial |
$88.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$88.50
|
| Rate for Payer: United Healthcare Commercial |
$106.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.62
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Herpes Simplex Virus IgM Antibody DMCL
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 86694
|
| Hospital Charge Code |
8037873
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna of IA Commercial |
$106.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.20
|
| Rate for Payer: Cash Price |
$94.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.50
|
| Rate for Payer: Medical Associates Commercial |
$88.50
|
| Rate for Payer: Midlands Choice Commercial |
$82.60
|
| Rate for Payer: United Healthcare Commercial |
$106.20
|
|
|
HERPES SIMPLEX VIRUS PCR
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8093935
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$99.93
|
| Rate for Payer: Amerigroup Medicare |
$99.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98.96
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.00
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$100.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$100.43
|
| Rate for Payer: Oscar Health of IA Commercial |
$148.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$148.50
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
HERPES SIMPLEX VIRUS PCR
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
8093935
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
hetastarch 60 mg/mL-NS IV Sol [VDMC]
|
Facility
|
IP
|
$107.64
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10393629
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.35 |
| Max. Negotiated Rate |
$96.88 |
| Rate for Payer: Aetna of IA Commercial |
$96.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.88
|
| Rate for Payer: Cash Price |
$86.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.73
|
| Rate for Payer: Medical Associates Commercial |
$80.73
|
| Rate for Payer: Midlands Choice Commercial |
$75.35
|
| Rate for Payer: United Healthcare Commercial |
$96.88
|
|
|
hetastarch 60 mg/mL-NS IV Sol [VDMC]
|
Facility
|
OP
|
$107.64
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10393629
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$96.88 |
| Rate for Payer: Aetna of IA Commercial |
$96.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$96.88
|
| Rate for Payer: Aetna of IA Medicare |
$61.35
|
| Rate for Payer: Amerigroup Medicaid |
$54.33
|
| Rate for Payer: Amerigroup Medicare |
$54.36
|
| Rate for Payer: Cash Price |
$86.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$80.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$53.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$53.80
|
| Rate for Payer: Medical Associates Commercial |
$80.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$53.82
|
| Rate for Payer: Midlands Choice Commercial |
$75.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54.63
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$54.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$80.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.73
|
| Rate for Payer: United Healthcare Commercial |
$96.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$63.51
|
|
|
Hgb A1C
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
1383763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Aetna of IA Medicare |
$43.89
|
| Rate for Payer: Amerigroup Medicaid |
$38.86
|
| Rate for Payer: Amerigroup Medicare |
$38.88
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.48
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.50
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$39.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$57.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.75
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.43
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Hgb A1C
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
1383763
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna of IA Commercial |
$69.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$69.30
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.75
|
| Rate for Payer: Medical Associates Commercial |
$57.75
|
| Rate for Payer: Midlands Choice Commercial |
$53.90
|
| Rate for Payer: United Healthcare Commercial |
$69.30
|
|
|
HHN/MDI DEMONSTRATE AND/OR EVAL
|
Facility
|
OP
|
$165.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
5338934
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$82.47 |
| Max. Negotiated Rate |
$218.24 |
| Rate for Payer: Aetna of IA Commercial |
$148.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$148.50
|
| Rate for Payer: Aetna of IA Medicare |
$94.05
|
| Rate for Payer: Amerigroup Medicaid |
$83.28
|
| Rate for Payer: Amerigroup Medicare |
$83.32
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$123.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$82.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$82.47
|
| Rate for Payer: Medical Associates Commercial |
$123.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$115.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$83.74
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$83.69
|
| Rate for Payer: Oscar Health of IA Commercial |
$123.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$123.75
|
| Rate for Payer: United Healthcare Commercial |
$148.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$97.35
|
| Rate for Payer: Wellmark IA HMO |
$198.40
|
| Rate for Payer: Wellmark IA PPO |
$218.24
|
|
|
HHN/MDI DEMONSTRATE AND/OR EVAL
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
5338934
|
|
Hospital Revenue Code
|
412
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Aetna of IA Commercial |
$148.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$148.50
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$123.75
|
| Rate for Payer: Medical Associates Commercial |
$123.75
|
| Rate for Payer: Midlands Choice Commercial |
$115.50
|
| Rate for Payer: United Healthcare Commercial |
$148.50
|
|
|
Hip and Femur Procedures Except Major Joint With CC
|
Facility
|
IP
|
$20,104.12
|
|
|
Service Code
|
MS-DRG 481
|
| Hospital Charge Code |
301
|
| Min. Negotiated Rate |
$19,812.76 |
| Max. Negotiated Rate |
$20,104.12 |
| Rate for Payer: Amerigroup Medicaid |
$20,007.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19,812.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,104.12
|
|
|
Hip and Femur Procedures Except Major Joint With MCC
|
Facility
|
IP
|
$27,465.26
|
|
|
Service Code
|
MS-DRG 480
|
| Hospital Charge Code |
300
|
| Min. Negotiated Rate |
$27,067.21 |
| Max. Negotiated Rate |
$27,465.26 |
| Rate for Payer: Amerigroup Medicaid |
$27,332.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27,067.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27,465.26
|
|
