Other Musculoskeletal System and Connective Tissue Diagnoses With CC
|
Facility
IP
|
$8,878.84
|
|
Service Code
|
MS-DRG 565
|
Hospital Charge Code |
372
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$8,878.84 |
Rate for Payer: Amerigroup Medicaid |
$8,835.95
|
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 |
$8,750.16
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$8,878.84
|
|
Other Musculoskeletal System and Connective Tissue Diagnoses With MCC
|
Facility
IP
|
$9,876.86
|
|
Service Code
|
MS-DRG 564
|
Hospital Charge Code |
371
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$9,876.86 |
Rate for Payer: Amerigroup Medicaid |
$9,829.15
|
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 |
$9,733.72
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$9,876.86
|
|
Other Musculoskeletal System and Connective Tissue Diagnoses Without CC/MCC
|
Facility
IP
|
$5,166.29
|
|
Service Code
|
MS-DRG 566
|
Hospital Charge Code |
373
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$5,166.29 |
Rate for Payer: Amerigroup Medicaid |
$5,141.33
|
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 |
$5,091.41
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$5,166.29
|
|
Other Musculoskeletal System and Connective Tissue O.R. Procedures With CC
|
Facility
IP
|
$17,967.33
|
|
Service Code
|
MS-DRG 516
|
Hospital Charge Code |
333
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$17,967.33 |
Rate for Payer: Amerigroup Medicaid |
$17,880.53
|
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 |
$17,706.93
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$17,967.33
|
|
Other Musculoskeletal System and Connective Tissue O.R. Procedures With MCC
|
Facility
IP
|
$26,002.68
|
|
Service Code
|
MS-DRG 515
|
Hospital Charge Code |
332
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$26,002.68 |
Rate for Payer: Amerigroup Medicaid |
$25,877.06
|
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 |
$25,625.83
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$26,002.68
|
|
Other Musculoskeletal System and Connective Tissue O.R. Procedures Without CC/MCC
|
Facility
IP
|
$14,372.88
|
|
Service Code
|
MS-DRG 517
|
Hospital Charge Code |
334
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$14,372.88 |
Rate for Payer: Amerigroup Medicaid |
$14,303.45
|
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 |
$14,164.58
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$14,372.88
|
|
Other Myeloproliferative Disorders or Poorly Differentiated Neoplastic Diagnoses With CC
|
Facility
IP
|
$8,712.51
|
|
Service Code
|
MS-DRG 844
|
Hospital Charge Code |
586
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$8,712.51 |
Rate for Payer: Amerigroup Medicaid |
$8,670.42
|
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 |
$8,586.24
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$8,712.51
|
|
Other Myeloproliferative Disorders or Poorly Differentiated Neoplastic Diagnoses With MCC
|
Facility
IP
|
$12,995.93
|
|
Service Code
|
MS-DRG 843
|
Hospital Charge Code |
585
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$12,995.93 |
Rate for Payer: Amerigroup Medicaid |
$12,933.14
|
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 |
$12,807.58
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$12,995.93
|
|
Other Myeloproliferative Disorders or Poorly Differentiated Neoplastic Diagnoses Without CC/MCC
|
Facility
IP
|
$8,342.43
|
|
Service Code
|
MS-DRG 845
|
Hospital Charge Code |
587
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$8,342.43 |
Rate for Payer: Amerigroup Medicaid |
$8,302.13
|
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 |
$8,221.53
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$8,342.43
|
|
Other O.R. Procedures for Injuries With CC
|
Facility
IP
|
$15,323.66
|
|
Service Code
|
MS-DRG 908
|
Hospital Charge Code |
629
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$15,323.66 |
Rate for Payer: Amerigroup Medicaid |
$15,249.63
|
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 |
$15,101.58
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$15,323.66
|
|
Other O.R. Procedures for Injuries With MCC
|
Facility
IP
|
$28,519.38
|
|
Service Code
|
MS-DRG 907
|
Hospital Charge Code |
628
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$28,519.38 |
Rate for Payer: Amerigroup Medicaid |
$28,381.61
|
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 |
$28,106.06
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$28,519.38
|
|
Other O.R. Procedures for Injuries Without CC/MCC
|
Facility
IP
|
$9,137.69
|
|
Service Code
|
MS-DRG 909
|
Hospital Charge Code |
630
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$9,137.69 |
Rate for Payer: Amerigroup Medicaid |
$9,093.55
|
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 |
$9,005.26
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$9,137.69
|
|
Other O.R. Procedures for Multiple Significant Trauma With CC
|
Facility
IP
|
$32,094.15
|
|
Service Code
|
MS-DRG 958
|
Hospital Charge Code |
661
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$32,094.15 |
Rate for Payer: Amerigroup Medicaid |
$31,939.11
|
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 |
$31,629.02
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$32,094.15
|
|
Other O.R. Procedures for Multiple Significant Trauma With MCC
|
Facility
IP
|
$58,260.21
|
|
Service Code
|
MS-DRG 957
|
Hospital Charge Code |
660
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$58,260.21 |
Rate for Payer: Amerigroup Medicaid |
$57,978.76
|
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 |
$57,415.86
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$58,260.21
|
|
Other O.R. Procedures for Multiple Significant Trauma Without CC/MCC
|
Facility
IP
|
$21,810.79
|
|
Service Code
|
MS-DRG 959
|
Hospital Charge Code |
662
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$21,810.79 |
Rate for Payer: Amerigroup Medicaid |
$21,705.43
|
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 |
$21,494.69
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$21,810.79
|
|
Other O.R. Procedures of the Blood and Blood Forming Organs With CC
|
Facility
IP
|
$16,475.22
|
|
Service Code
|
MS-DRG 803
|
Hospital Charge Code |
545
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$16,475.22 |
Rate for Payer: Amerigroup Medicaid |
$16,395.63
|
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 |
$16,236.45
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$16,475.22
|
|
Other O.R. Procedures of the Blood and Blood Forming Organs With MCC
|
Facility
IP
|
$36,512.41
|
|
Service Code
|
MS-DRG 802
|
Hospital Charge Code |
544
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$36,512.41 |
Rate for Payer: Amerigroup Medicaid |
$36,336.02
|
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 |
$35,983.24
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$36,512.41
|
|
Other O.R. Procedures of the Blood and Blood Forming Organs Without CC/MCC
|
Facility
IP
|
$11,632.75
|
|
Service Code
|
MS-DRG 804
|
Hospital Charge Code |
546
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$11,632.75 |
Rate for Payer: Amerigroup Medicaid |
$11,576.55
|
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 |
$11,464.16
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$11,632.75
|
|
Other Respiratory System Diagnoses With MCC
|
Facility
IP
|
$11,446.73
|
|
Service Code
|
MS-DRG 205
|
Hospital Charge Code |
76
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$11,446.73 |
Rate for Payer: Amerigroup Medicaid |
$11,391.43
|
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 |
$11,280.83
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$11,446.73
|
|
Other Respiratory System Diagnoses Without MCC
|
Facility
IP
|
$6,744.02
|
|
Service Code
|
MS-DRG 206
|
Hospital Charge Code |
77
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$6,744.02 |
Rate for Payer: Amerigroup Medicaid |
$6,711.44
|
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 |
$6,646.28
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$6,744.02
|
|
Other Respiratory System O.R. Procedures With CC
|
Facility
IP
|
$16,549.04
|
|
Service Code
|
MS-DRG 167
|
Hospital Charge Code |
44
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$16,549.04 |
Rate for Payer: Amerigroup Medicaid |
$16,469.09
|
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 |
$16,309.20
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$16,549.04
|
|
Other Respiratory System O.R. Procedures With MCC
|
Facility
IP
|
$30,598.10
|
|
Service Code
|
MS-DRG 166
|
Hospital Charge Code |
43
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$30,598.10 |
Rate for Payer: Amerigroup Medicaid |
$30,450.28
|
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 |
$30,154.65
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$30,598.10
|
|
Other Respiratory System O.R. Procedures Without CC/MCC
|
Facility
IP
|
$12,104.20
|
|
Service Code
|
MS-DRG 168
|
Hospital Charge Code |
45
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$12,104.20 |
Rate for Payer: Amerigroup Medicaid |
$12,045.73
|
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 |
$11,928.78
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$12,104.20
|
|
Other Skin, Subcutaneous Tissue and Breast Procedures With CC
|
Facility
IP
|
$11,584.53
|
|
Service Code
|
MS-DRG 580
|
Hospital Charge Code |
384
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$11,584.53 |
Rate for Payer: Amerigroup Medicaid |
$11,528.56
|
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 |
$11,416.64
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$11,584.53
|
|
Other Skin, Subcutaneous Tissue and Breast Procedures With MCC
|
Facility
IP
|
$17,367.92
|
|
Service Code
|
MS-DRG 579
|
Hospital Charge Code |
383
|
Min. Negotiated Rate |
$2,034.00 |
Max. Negotiated Rate |
$17,367.92 |
Rate for Payer: Amerigroup Medicaid |
$17,284.02
|
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 |
$17,116.21
|
Rate for Payer: Molina Healthcare Managed Medicaid |
$17,367.92
|
|