|
OMEGA 4.75MM PEEK KNOTLESS ANCHOR SYSTEM
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8771316
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: Aetna of IA Commercial |
$688.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$688.50
|
| Rate for Payer: Cash Price |
$612.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$573.75
|
| Rate for Payer: Medical Associates Commercial |
$573.75
|
| Rate for Payer: Midlands Choice Commercial |
$535.50
|
| Rate for Payer: United Healthcare Commercial |
$688.50
|
|
|
omeprazole 20 mg Oral DR Cap [VDMC]
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| 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: Cash Price |
$1.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.11
|
| Rate for Payer: Medical Associates Commercial |
$1.11
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
|
|
omeprazole 20 mg Oral DR Cap [VDMC]
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410347
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.67 |
| 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 |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.67
|
| 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 |
$0.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$1.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.67
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.87
|
|
|
onabotulinumtoxinA 100 units Pow [VDMC]
|
Facility
|
OP
|
$1,368.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
10410416
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$615.60 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,231.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,231.20
|
| Rate for Payer: Aetna of IA Medicare |
$779.76
|
| Rate for Payer: Amerigroup Medicaid |
$789.06
|
| Rate for Payer: Amerigroup Medicare |
$621.76
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,026.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$615.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$781.40
|
| Rate for Payer: Medical Associates Commercial |
$1,026.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$615.60
|
| Rate for Payer: Midlands Choice Commercial |
$957.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$792.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$707.94
|
| Rate for Payer: United Healthcare Commercial |
$1,231.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$807.12
|
|
|
onabotulinumtoxinA 100 units Pow [VDMC]
|
Facility
|
IP
|
$1,368.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
10410416
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$957.60 |
| Max. Negotiated Rate |
$1,231.20 |
| Rate for Payer: Aetna of IA Commercial |
$1,231.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,231.20
|
| Rate for Payer: Cash Price |
$1,094.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,026.00
|
| Rate for Payer: Medical Associates Commercial |
$1,026.00
|
| Rate for Payer: Midlands Choice Commercial |
$957.60
|
| Rate for Payer: United Healthcare Commercial |
$1,231.20
|
|
|
ondansetron 2 mg/mL 2 ML Inj SDV [VDMC]
|
Facility
|
IP
|
$20.96
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10410483
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.67 |
| Max. Negotiated Rate |
$18.87 |
| Rate for Payer: Aetna of IA Commercial |
$18.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.87
|
| 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 |
$18.87
|
|
|
ondansetron 2 mg/mL 2 ML Inj SDV [VDMC]
|
Facility
|
OP
|
$20.96
|
|
|
Service Code
|
HCPCS J2405
|
| Hospital Charge Code |
10410483
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.43 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$18.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$18.87
|
| Rate for Payer: Aetna of IA Medicare |
$11.95
|
| Rate for Payer: Amerigroup Medicaid |
$12.09
|
| Rate for Payer: Amerigroup Medicare |
$9.53
|
| Rate for Payer: Cash Price |
$16.77
|
| 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 |
$9.43
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.97
|
| Rate for Payer: Medical Associates Commercial |
$15.72
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.43
|
| Rate for Payer: Midlands Choice Commercial |
$14.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.85
|
| Rate for Payer: United Healthcare Commercial |
$18.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$12.37
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
ondansetron 4 mg Dis Tab [VDMC]
|
Facility
|
OP
|
$2.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410554
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna of IA Commercial |
$2.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.13
|
| Rate for Payer: Aetna of IA Medicare |
$1.35
|
| Rate for Payer: Amerigroup Medicaid |
$1.37
|
| Rate for Payer: Amerigroup Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.07
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.35
|
| Rate for Payer: Medical Associates Commercial |
$1.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.07
|
| Rate for Payer: Midlands Choice Commercial |
$1.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.22
|
| Rate for Payer: United Healthcare Commercial |
$2.13
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.40
|
|
|
ondansetron 4 mg Dis Tab [VDMC]
|
Facility
|
IP
|
$2.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10410554
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.13 |
| Rate for Payer: Aetna of IA Commercial |
$2.13
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.13
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.78
|
| Rate for Payer: Medical Associates Commercial |
$1.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$2.13
|
|
|
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
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
8663517
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$406.12 |
| 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 |
$82.48
|
| Rate for Payer: Amerigroup Medicare |
$64.99
|
| 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 |
$64.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.68
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.35
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.00
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.37
|
| Rate for Payer: Wellmark IA HMO WHPI |
$368.68
|
| Rate for Payer: Wellmark IA PPO |
$406.12
|
|
|
Ongoing - KX
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 93668 KX
|
| Hospital Charge Code |
8663516
|
|
Hospital Revenue Code
|
943
|
| Min. Negotiated Rate |
$64.35 |
| Max. Negotiated Rate |
$406.12 |
| 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 |
$82.48
|
| Rate for Payer: Amerigroup Medicare |
$64.99
|
| 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 |
$64.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$81.68
|
| Rate for Payer: Medical Associates Commercial |
$107.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.35
|
| Rate for Payer: Midlands Choice Commercial |
$100.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.00
|
| Rate for Payer: United Healthcare Commercial |
$128.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$84.37
|
| Rate for Payer: Wellmark IA HMO WHPI |
$368.68
|
| Rate for Payer: Wellmark IA PPO |
$406.12
|
|
|
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
|
|
|
OPEN TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG, LATERAL AND MEDIAL MALLEOLI, OR LATERAL AND POSTERIOR MALLEOLI, OR MEDIAL AND POSTERIOR MALLEOLI), INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$10,774.68
|
|
|
Service Code
|
CPT 27814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,781.36 |
| Max. Negotiated Rate |
$10,774.68 |
| Rate for Payer: Wellmark IA HMO WHPI |
$9,781.36
|
| Rate for Payer: Wellmark IA PPO |
$10,774.68
|
|
|
OPEN TREATMENT OF FRACTURE, GREAT TOE, PHALANX OR PHALANGES, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$10,774.68
|
|
|
Service Code
|
CPT 28505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,781.36 |
| Max. Negotiated Rate |
$10,774.68 |
| Rate for Payer: Wellmark IA HMO WHPI |
$9,781.36
|
| Rate for Payer: Wellmark IA PPO |
$10,774.68
|
|
|
OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED
|
Facility
|
OP
|
$10,774.68
|
|
|
Service Code
|
CPT 27766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,781.36 |
| Max. Negotiated Rate |
$10,774.68 |
| Rate for Payer: Wellmark IA HMO WHPI |
$9,781.36
|
| Rate for Payer: Wellmark IA PPO |
$10,774.68
|
|
|
ophthalmic irrigation, extraocular - Sol [VDMC]
|
Facility
|
OP
|
$29.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11223386
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.28 |
| 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 |
$17.03
|
| Rate for Payer: Amerigroup Medicare |
$13.42
|
| Rate for Payer: Cash Price |
$23.62
|
| 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 |
$13.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.86
|
| Rate for Payer: Medical Associates Commercial |
$22.14
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.28
|
| Rate for Payer: Midlands Choice Commercial |
$20.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$15.28
|
| Rate for Payer: United Healthcare Commercial |
$26.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.42
|
|
|
ophthalmic irrigation, extraocular - Sol [VDMC]
|
Facility
|
IP
|
$29.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11223386
|
|
Hospital Revenue Code
|
259
|
| 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 |
$23.62
|
| 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
|
|
|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$24,685.92
|
|
|
Service Code
|
MSDRG 113
|
| Min. Negotiated Rate |
$24,328.14 |
| Max. Negotiated Rate |
$24,685.92 |
| Rate for Payer: Amerigroup Medicaid |
$24,566.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$24,328.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$24,685.92
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$13,187.44
|
|
|
Service Code
|
MSDRG 114
|
| Min. Negotiated Rate |
$12,996.31 |
| Max. Negotiated Rate |
$13,187.44 |
| Rate for Payer: Amerigroup Medicaid |
$13,123.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,996.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,187.44
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$7,620.61
|
|
|
Service Code
|
MSDRG 884
|
| Min. Negotiated Rate |
$7,510.17 |
| Max. Negotiated Rate |
$7,620.61 |
| Rate for Payer: Amerigroup Medicaid |
$7,583.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,510.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,620.61
|
|
|
orphenadrine citrate 60 mg/2ml soln [VDMC]
|
Facility
|
IP
|
$32.42
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
10429845
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$29.18 |
| Rate for Payer: Aetna of IA Commercial |
$29.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.18
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.32
|
| Rate for Payer: Medical Associates Commercial |
$24.32
|
| Rate for Payer: Midlands Choice Commercial |
$22.70
|
| Rate for Payer: United Healthcare Commercial |
$29.18
|
|
|
orphenadrine citrate 60 mg/2ml soln [VDMC]
|
Facility
|
OP
|
$32.42
|
|
|
Service Code
|
HCPCS J2360
|
| Hospital Charge Code |
10429845
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$29.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.18
|
| Rate for Payer: Aetna of IA Medicare |
$18.48
|
| Rate for Payer: Amerigroup Medicaid |
$18.70
|
| Rate for Payer: Amerigroup Medicare |
$14.74
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Cash Price |
$25.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.52
|
| Rate for Payer: Medical Associates Commercial |
$24.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.59
|
| Rate for Payer: Midlands Choice Commercial |
$22.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.78
|
| Rate for Payer: United Healthcare Commercial |
$29.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.13
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
O.R. PROCEDURES FOR OBESITY WITH CC
|
Facility
|
IP
|
$16,652.07
|
|
|
Service Code
|
MSDRG 620
|
| Min. Negotiated Rate |
$16,410.73 |
| Max. Negotiated Rate |
$16,652.07 |
| Rate for Payer: Amerigroup Medicaid |
$16,571.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16,410.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,652.07
|
|
|
O.R. PROCEDURES FOR OBESITY WITH MCC
|
Facility
|
IP
|
$28,399.39
|
|
|
Service Code
|
MSDRG 619
|
| Min. Negotiated Rate |
$27,987.79 |
| Max. Negotiated Rate |
$28,399.39 |
| Rate for Payer: Amerigroup Medicaid |
$28,262.18
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27,987.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28,399.39
|
|
