|
omeprazole 20 mg Oral DR Cap
|
Facility
OP
|
$1.48
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43788401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna of IA Commercial |
$1.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.33
|
| Rate for Payer: Aetna of IA Medicare |
$0.84
|
| Rate for Payer: Amerigroup Medicaid |
$0.75
|
| Rate for Payer: Amerigroup Medicare |
$0.75
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.11
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.74
|
| Rate for Payer: Medical Associates Commercial |
$1.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.74
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.87
|
|
|
onabotulinumtoxinA 100 units Pow
|
Facility
OP
|
$1,302.00
|
|
|
Service Code
|
CPT J0585
|
| Hospital Charge Code |
43789156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$650.74 |
| Max. Negotiated Rate |
$1,171.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,171.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,171.80
|
| Rate for Payer: Aetna of IA Medicare |
$742.14
|
| Rate for Payer: Amerigroup Medicaid |
$657.12
|
| Rate for Payer: Amerigroup Medicare |
$657.51
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$976.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$651.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$650.74
|
| Rate for Payer: Medical Associates Commercial |
$976.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$651.00
|
| Rate for Payer: Midlands Choice Commercial |
$911.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$660.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$976.50
|
| Rate for Payer: United Healthcare Commercial |
$1,171.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$768.18
|
|
|
onabotulinumtoxinA 100 units Pow
|
Facility
IP
|
$1,302.00
|
|
|
Service Code
|
CPT J0585
|
| Hospital Charge Code |
43789156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$911.40 |
| Max. Negotiated Rate |
$1,171.80 |
| Rate for Payer: Aetna of IA Commercial |
$1,171.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$976.50
|
| Rate for Payer: Medical Associates Commercial |
$976.50
|
| Rate for Payer: Midlands Choice Commercial |
$911.40
|
| Rate for Payer: United Healthcare Commercial |
$1,171.80
|
|
|
ondansetron 2 mg/mL 2 ML Inj SDV
|
Facility
IP
|
$20.96
|
|
|
Service Code
|
CPT J2405
|
| Hospital Charge Code |
43701874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.67 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna of IA Commercial |
$18.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.86
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.72
|
| Rate for Payer: Medical Associates Commercial |
$15.72
|
| Rate for Payer: Midlands Choice Commercial |
$14.67
|
| Rate for Payer: United Healthcare Commercial |
$18.86
|
|
|
ondansetron 2 mg/mL 2 ML Inj SDV
|
Facility
OP
|
$20.96
|
|
|
Service Code
|
CPT J2405
|
| Hospital Charge Code |
43701874
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna of IA Commercial |
$18.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.86
|
| Rate for Payer: Aetna of IA Medicare |
$11.95
|
| Rate for Payer: Amerigroup Medicaid |
$10.58
|
| Rate for Payer: Amerigroup Medicare |
$10.58
|
| Rate for Payer: Cash Price |
$16.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$15.72
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.48
|
| Rate for Payer: Medical Associates Commercial |
$15.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.48
|
| Rate for Payer: Midlands Choice Commercial |
$14.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.72
|
| Rate for Payer: United Healthcare Commercial |
$18.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.37
|
|
|
ondansetron 4 mg Dis Tab
|
Facility
OP
|
$2.00
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of IA Commercial |
$1.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.80
|
| Rate for Payer: Aetna of IA Medicare |
$1.14
|
| Rate for Payer: Amerigroup Medicaid |
$1.01
|
| Rate for Payer: Amerigroup Medicare |
$1.01
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.00
|
| Rate for Payer: Medical Associates Commercial |
$1.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.00
|
| Rate for Payer: Midlands Choice Commercial |
$1.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.50
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.18
|
|
|
ondansetron 4 mg Dis Tab
|
Facility
IP
|
$2.00
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700122
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Aetna of IA Commercial |
$1.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.80
|
| Rate for Payer: Cash Price |
$1.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.50
|
| Rate for Payer: Medical Associates Commercial |
$1.50
|
| Rate for Payer: Midlands Choice Commercial |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$1.80
|
|
|
Ongoing
|
Facility
OP
|
$143.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
8663517
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$71.47 |
| Max. Negotiated Rate |
$443.98 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Aetna of IA Medicare |
$81.51
|
| Rate for Payer: Amerigroup Medicaid |
$72.17
|
| Rate for Payer: Amerigroup Medicare |
$72.22
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$71.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.47
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.50
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$107.25
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.37
|
| Rate for Payer: Wellmark IA HMO |
$403.62
|
| Rate for Payer: Wellmark IA PPO |
$443.98
|
|
|
Ongoing
|
Facility
IP
|
$143.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
8663517
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
|
|
Ongoing - KX
|
Facility
IP
|
$143.00
|
|
|
Service Code
|
CPT 93668 KX
|
| Hospital Charge Code |
8663516
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$100.10 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
|
|
Ongoing - KX
|
Facility
OP
|
$143.00
|
|
|
Service Code
|
CPT 93668 KX
|
| Hospital Charge Code |
8663516
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$71.47 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Aetna of IA Commercial |
$128.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$128.70
|
| Rate for Payer: Aetna of IA Medicare |
$81.51
|
| Rate for Payer: Amerigroup Medicaid |
$72.17
|
| Rate for Payer: Amerigroup Medicare |
$72.22
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$107.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$71.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.47
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$71.50
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$72.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$107.25
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.37
|
|
|
Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed
|
Facility
OP
|
$9,670.76
|
|
|
Service Code
|
CPT 27792
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,791.60 |
| Max. Negotiated Rate |
$9,670.76 |
| Rate for Payer: Wellmark IA HMO |
$8,791.60
|
| Rate for Payer: Wellmark IA PPO |
$9,670.76
|
|
|
Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed
|
Facility
OP
|
$9,670.76
|
|
|
Service Code
|
CPT 27829
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,791.60 |
| Max. Negotiated Rate |
$9,670.76 |
| Rate for Payer: Wellmark IA HMO |
$8,791.60
|
| Rate for Payer: Wellmark IA PPO |
$9,670.76
|
|
|
Open treatment of metatarsal fracture, includes internal fixation, when performed, each
|
Facility
OP
|
$9,670.76
|
|
|
Service Code
|
CPT 28485
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,791.60 |
| Max. Negotiated Rate |
$9,670.76 |
| Rate for Payer: Wellmark IA HMO |
$8,791.60
|
| Rate for Payer: Wellmark IA PPO |
$9,670.76
|
|
|
Open treatment of talus fracture, includes internal fixation, when performed
|
Facility
OP
|
$9,670.76
|
|
|
Service Code
|
CPT 28445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,791.60 |
| Max. Negotiated Rate |
$9,670.76 |
| Rate for Payer: Wellmark IA HMO |
$8,791.60
|
| Rate for Payer: Wellmark IA PPO |
$9,670.76
|
|
|
Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip
|
Facility
OP
|
$9,670.76
|
|
|
Service Code
|
CPT 27822
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,791.60 |
| Max. Negotiated Rate |
$9,670.76 |
| Rate for Payer: Wellmark IA HMO |
$8,791.60
|
| Rate for Payer: Wellmark IA PPO |
$9,670.76
|
|
|
ophthalmic irrigation, extraocular
|
Facility
IP
|
$29.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.66 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Aetna of IA Commercial |
$26.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.57
|
| Rate for Payer: Cash Price |
$23.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.14
|
| Rate for Payer: Medical Associates Commercial |
$22.14
|
| Rate for Payer: Midlands Choice Commercial |
$20.66
|
| Rate for Payer: United Healthcare Commercial |
$26.57
|
|
|
ophthalmic irrigation, extraocular
|
Facility
OP
|
$29.52
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700391
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$26.57 |
| Rate for Payer: Aetna of IA Commercial |
$26.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$26.57
|
| Rate for Payer: Aetna of IA Medicare |
$16.83
|
| Rate for Payer: Amerigroup Medicaid |
$14.90
|
| Rate for Payer: Amerigroup Medicare |
$14.91
|
| Rate for Payer: Cash Price |
$23.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.76
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.75
|
| Rate for Payer: Medical Associates Commercial |
$22.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.76
|
| Rate for Payer: Midlands Choice Commercial |
$20.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.14
|
| Rate for Payer: United Healthcare Commercial |
$26.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.42
|
|
|
Orbital Procedures With CC/MCC
|
Facility
IP
|
$21,578.51
|
|
|
Service Code
|
MS-DRG 113
|
| Hospital Charge Code |
5
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$21,578.51 |
| Rate for Payer: Amerigroup Medicaid |
$21,474.26
|
| 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 |
$21,265.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21,578.51
|
|
|
Orbital Procedures Without CC/MCC
|
Facility
IP
|
$11,527.44
|
|
|
Service Code
|
MS-DRG 114
|
| Hospital Charge Code |
6
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,527.44 |
| Rate for Payer: Amerigroup Medicaid |
$11,471.75
|
| 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 |
$11,360.37
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,527.44
|
|
|
Organic Disturbances and Intellectual Disability
|
Facility
IP
|
$6,661.34
|
|
|
Service Code
|
MS-DRG 884
|
| Hospital Charge Code |
614
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,661.34 |
| Rate for Payer: Amerigroup Medicaid |
$6,629.16
|
| 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 |
$6,564.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,661.34
|
|
|
orphenadrine citrate 60 mg/2ml soln
|
Facility
IP
|
$32.40
|
|
|
Service Code
|
CPT J2360
|
| Hospital Charge Code |
43754130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna of IA Commercial |
$29.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.16
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.30
|
| Rate for Payer: Medical Associates Commercial |
$24.30
|
| Rate for Payer: Midlands Choice Commercial |
$22.68
|
| Rate for Payer: United Healthcare Commercial |
$29.16
|
|
|
orphenadrine citrate 60 mg/2ml soln
|
Facility
OP
|
$32.40
|
|
|
Service Code
|
CPT J2360
|
| Hospital Charge Code |
43754130
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$29.16 |
| Rate for Payer: Aetna of IA Commercial |
$29.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.16
|
| Rate for Payer: Aetna of IA Medicare |
$18.47
|
| Rate for Payer: Amerigroup Medicaid |
$16.35
|
| Rate for Payer: Amerigroup Medicare |
$16.36
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.19
|
| Rate for Payer: Medical Associates Commercial |
$24.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.20
|
| Rate for Payer: Midlands Choice Commercial |
$22.68
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.30
|
| Rate for Payer: United Healthcare Commercial |
$29.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.12
|
|
|
O.R. Procedures for Obesity With CC
|
Facility
IP
|
$14,555.95
|
|
|
Service Code
|
MS-DRG 620
|
| Hospital Charge Code |
412
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,555.95 |
| Rate for Payer: Amerigroup Medicaid |
$14,485.63
|
| 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 |
$14,344.99
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,555.95
|
|
|
O.R. Procedures for Obesity With MCC
|
Facility
IP
|
$24,824.54
|
|
|
Service Code
|
MS-DRG 619
|
| Hospital Charge Code |
411
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$24,824.54 |
| Rate for Payer: Amerigroup Medicaid |
$24,704.61
|
| 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 |
$24,464.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24,824.54
|
|
