|
Respiratory Panel 2.1 (BioFire)
|
Facility
IP
|
$661.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
8789842
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$462.70 |
| Max. Negotiated Rate |
$594.90 |
| Rate for Payer: Aetna of IA Commercial |
$594.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$594.90
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$495.75
|
| Rate for Payer: Medical Associates Commercial |
$495.75
|
| Rate for Payer: Midlands Choice Commercial |
$462.70
|
| Rate for Payer: United Healthcare Commercial |
$594.90
|
|
|
Respiratory Panel 2.1 (BioFire)
|
Facility
OP
|
$661.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
8789842
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$314.34 |
| Max. Negotiated Rate |
$594.90 |
| Rate for Payer: Aetna of IA Commercial |
$594.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$594.90
|
| Rate for Payer: Aetna of IA Medicare |
$376.77
|
| Rate for Payer: Amerigroup Medicaid |
$333.61
|
| Rate for Payer: Amerigroup Medicare |
$333.80
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$495.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$330.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$330.37
|
| Rate for Payer: Medical Associates Commercial |
$495.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$330.50
|
| Rate for Payer: Midlands Choice Commercial |
$462.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$335.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$495.75
|
| Rate for Payer: United Healthcare Commercial |
$594.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$389.99
|
| Rate for Payer: Wellmark IA HMO |
$314.34
|
| Rate for Payer: Wellmark IA PPO |
$345.77
|
|
|
Respiratory Panel by PCR
|
Facility
IP
|
$661.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
8757579
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$462.70 |
| Max. Negotiated Rate |
$594.90 |
| Rate for Payer: Aetna of IA Commercial |
$594.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$594.90
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$495.75
|
| Rate for Payer: Medical Associates Commercial |
$495.75
|
| Rate for Payer: Midlands Choice Commercial |
$462.70
|
| Rate for Payer: United Healthcare Commercial |
$594.90
|
|
|
Respiratory Panel by PCR
|
Facility
OP
|
$661.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
8757579
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$314.34 |
| Max. Negotiated Rate |
$594.90 |
| Rate for Payer: Aetna of IA Commercial |
$594.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$594.90
|
| Rate for Payer: Aetna of IA Medicare |
$376.77
|
| Rate for Payer: Amerigroup Medicaid |
$333.61
|
| Rate for Payer: Amerigroup Medicare |
$333.80
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$495.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$330.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$330.37
|
| Rate for Payer: Medical Associates Commercial |
$495.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$330.50
|
| Rate for Payer: Midlands Choice Commercial |
$462.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$335.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$495.75
|
| Rate for Payer: United Healthcare Commercial |
$594.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$389.99
|
| Rate for Payer: Wellmark IA HMO |
$314.34
|
| Rate for Payer: Wellmark IA PPO |
$345.77
|
|
|
Respiratory Signs and Symptoms
|
Facility
IP
|
$5,582.61
|
|
|
Service Code
|
MS-DRG 204
|
| Hospital Charge Code |
75
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,582.61 |
| Rate for Payer: Amerigroup Medicaid |
$5,555.64
|
| 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 |
$5,501.71
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,582.61
|
|
|
Respiratory System Diagnosis With Ventilator Support <=96 Hours
|
Facility
IP
|
$18,396.46
|
|
|
Service Code
|
MS-DRG 208
|
| Hospital Charge Code |
79
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$18,396.46 |
| Rate for Payer: Amerigroup Medicaid |
$18,307.59
|
| 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 |
$18,129.85
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,396.46
|
|
|
Respiratory System Diagnosis With Ventilator Support >96 Hours
|
Facility
IP
|
$54,005.34
|
|
|
Service Code
|
MS-DRG 207
|
| Hospital Charge Code |
78
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$54,005.34 |
| Rate for Payer: Amerigroup Medicaid |
$53,744.44
|
| 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 |
$53,222.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$54,005.34
|
|
|
RESTRATA 1X1 SOFT TISSUE REPAIR
|
Facility
IP
|
$1,599.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8885369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,119.30 |
| Max. Negotiated Rate |
$1,439.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,439.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,439.10
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,199.25
|
| Rate for Payer: Medical Associates Commercial |
$1,199.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,119.30
|
| Rate for Payer: United Healthcare Commercial |
$1,439.10
|
|
|
RESTRATA 1X1 SOFT TISSUE REPAIR
|
Facility
OP
|
$1,599.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8885369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$799.18 |
| Max. Negotiated Rate |
$1,439.10 |
| Rate for Payer: Aetna of IA Commercial |
$1,439.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,439.10
|
| Rate for Payer: Aetna of IA Medicare |
$911.43
|
| Rate for Payer: Amerigroup Medicaid |
$807.02
|
| Rate for Payer: Amerigroup Medicare |
$807.50
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,199.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$799.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$799.18
|
| Rate for Payer: Medical Associates Commercial |
$1,199.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$799.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,119.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$811.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,199.25
|
| Rate for Payer: United Healthcare Commercial |
$1,439.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$943.41
|
|
|
Restrata 1x2 soft tissue repair
|
Facility
OP
|
$2,925.00
|
|
|
Service Code
|
CPT c1713
|
| Hospital Charge Code |
8874155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,461.92 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,632.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,632.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,667.25
|
| Rate for Payer: Amerigroup Medicaid |
$1,476.25
|
| Rate for Payer: Amerigroup Medicare |
$1,477.12
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,193.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,462.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,461.92
|
| Rate for Payer: Medical Associates Commercial |
$2,193.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,462.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,047.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,484.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,193.75
|
| Rate for Payer: United Healthcare Commercial |
$2,632.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,725.75
|
|
|
Restrata 1x2 soft tissue repair
|
Facility
IP
|
$2,925.00
|
|
|
Service Code
|
CPT c1713
|
| Hospital Charge Code |
8874155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,047.50 |
| Max. Negotiated Rate |
$2,632.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,632.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,632.50
|
| Rate for Payer: Cash Price |
$2,340.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,193.75
|
| Rate for Payer: Medical Associates Commercial |
$2,193.75
|
| Rate for Payer: Midlands Choice Commercial |
$2,047.50
|
| Rate for Payer: United Healthcare Commercial |
$2,632.50
|
|
|
Restrata 3x3 RMW1
|
Facility
IP
|
$6,075.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8942331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,252.50 |
| Max. Negotiated Rate |
$5,467.50 |
| Rate for Payer: Aetna of IA Commercial |
$5,467.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,467.50
|
| Rate for Payer: Cash Price |
$4,860.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,556.25
|
| Rate for Payer: Medical Associates Commercial |
$4,556.25
|
| Rate for Payer: Midlands Choice Commercial |
$4,252.50
|
| Rate for Payer: United Healthcare Commercial |
$5,467.50
|
|
|
Restrata 3x3 RMW1
|
Facility
OP
|
$6,075.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8942331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,036.28 |
| Max. Negotiated Rate |
$5,467.50 |
| Rate for Payer: Aetna of IA Commercial |
$5,467.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,467.50
|
| Rate for Payer: Aetna of IA Medicare |
$3,462.75
|
| Rate for Payer: Amerigroup Medicaid |
$3,066.05
|
| Rate for Payer: Amerigroup Medicare |
$3,067.88
|
| Rate for Payer: Cash Price |
$4,860.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,556.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,037.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,036.28
|
| Rate for Payer: Medical Associates Commercial |
$4,556.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,037.50
|
| Rate for Payer: Midlands Choice Commercial |
$4,252.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,083.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,556.25
|
| Rate for Payer: United Healthcare Commercial |
$5,467.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,584.25
|
|
|
RESTRATA 5PK 1X1 5PK 1X2
|
Facility
OP
|
$18,497.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8943983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,244.80 |
| Max. Negotiated Rate |
$16,647.30 |
| Rate for Payer: Aetna of IA Commercial |
$16,647.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16,647.30
|
| Rate for Payer: Aetna of IA Medicare |
$10,543.29
|
| Rate for Payer: Amerigroup Medicaid |
$9,335.44
|
| Rate for Payer: Amerigroup Medicare |
$9,340.98
|
| Rate for Payer: Cash Price |
$14,797.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13,872.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9,248.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,244.80
|
| Rate for Payer: Medical Associates Commercial |
$13,872.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$9,248.50
|
| Rate for Payer: Midlands Choice Commercial |
$12,947.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,387.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$13,872.75
|
| Rate for Payer: United Healthcare Commercial |
$16,647.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$10,913.23
|
|
|
RESTRATA 5PK 1X1 5PK 1X2
|
Facility
IP
|
$18,497.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8943983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,947.90 |
| Max. Negotiated Rate |
$16,647.30 |
| Rate for Payer: Aetna of IA Commercial |
$16,647.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16,647.30
|
| Rate for Payer: Cash Price |
$14,797.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13,872.75
|
| Rate for Payer: Medical Associates Commercial |
$13,872.75
|
| Rate for Payer: Midlands Choice Commercial |
$12,947.90
|
| Rate for Payer: United Healthcare Commercial |
$16,647.30
|
|
|
Reticulocyte Count DMCL
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
8037796
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
|
|
Reticulocyte Count DMCL
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 85045
|
| Hospital Charge Code |
8037796
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$53.10 |
| Rate for Payer: Aetna of IA Commercial |
$53.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.10
|
| Rate for Payer: Aetna of IA Medicare |
$33.63
|
| Rate for Payer: Amerigroup Medicaid |
$29.78
|
| Rate for Payer: Amerigroup Medicare |
$29.80
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.49
|
| Rate for Payer: Medical Associates Commercial |
$44.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.50
|
| Rate for Payer: Midlands Choice Commercial |
$41.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.25
|
| Rate for Payer: United Healthcare Commercial |
$53.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.81
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
Reticuloendothelial and Immunity Disorders With CC
|
Facility
IP
|
$8,002.87
|
|
|
Service Code
|
MS-DRG 815
|
| Hospital Charge Code |
557
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,002.87 |
| Rate for Payer: Amerigroup Medicaid |
$7,964.21
|
| 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 |
$7,886.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,002.87
|
|
|
Reticuloendothelial and Immunity Disorders With MCC
|
Facility
IP
|
$18,613.98
|
|
|
Service Code
|
MS-DRG 814
|
| Hospital Charge Code |
556
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$18,613.98 |
| Rate for Payer: Amerigroup Medicaid |
$18,524.06
|
| 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 |
$18,344.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,613.98
|
|
|
Reticuloendothelial and Immunity Disorders Without CC/MCC
|
Facility
IP
|
$6,789.30
|
|
|
Service Code
|
MS-DRG 816
|
| Hospital Charge Code |
558
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,789.30 |
| Rate for Payer: Amerigroup Medicaid |
$6,756.50
|
| 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 |
$6,690.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,789.30
|
|
|
REVISE SPINE ELTRD PERQ ARAY
|
Professional
|
$2,602.00
|
|
|
Service Code
|
CPT 63663
|
| Hospital Charge Code |
8015893
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$410.44 |
| Max. Negotiated Rate |
$1,821.40 |
| Rate for Payer: Aetna of IA Medicare |
$410.44
|
| Rate for Payer: Amerigroup Medicaid |
$424.39
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Cash Price |
$2,081.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$492.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$418.65
|
| Rate for Payer: Medical Associates Commercial |
$779.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$410.44
|
| Rate for Payer: Midlands Choice Commercial |
$1,821.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$615.66
|
| Rate for Payer: Wellmark IA HMO |
$802.00
|
| Rate for Payer: Wellmark IA PPO |
$941.00
|
|
|
REVISE SPINE ELTRD PLATE
|
Professional
|
$2,930.00
|
|
|
Service Code
|
CPT 63664
|
| Hospital Charge Code |
8015888
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$779.82 |
| Max. Negotiated Rate |
$2,051.00 |
| Rate for Payer: Aetna of IA Medicare |
$779.82
|
| Rate for Payer: Amerigroup Medicaid |
$806.33
|
| Rate for Payer: Cash Price |
$2,344.00
|
| Rate for Payer: Cash Price |
$2,344.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$935.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$795.42
|
| Rate for Payer: Medical Associates Commercial |
$1,481.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$779.82
|
| Rate for Payer: Midlands Choice Commercial |
$2,051.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,169.73
|
| Rate for Payer: Wellmark IA HMO |
$1,598.00
|
| Rate for Payer: Wellmark IA PPO |
$1,876.00
|
|
|
Revision of Hip or Knee Replacement With CC
|
Facility
IP
|
$33,409.10
|
|
|
Service Code
|
MS-DRG 467
|
| Hospital Charge Code |
287
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$33,409.10 |
| Rate for Payer: Amerigroup Medicaid |
$33,247.70
|
| 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 |
$32,924.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33,409.10
|
|
|
Revision of Hip or Knee Replacement With MCC
|
Facility
IP
|
$34,122.67
|
|
|
Service Code
|
MS-DRG 466
|
| Hospital Charge Code |
286
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$34,122.67 |
| Rate for Payer: Amerigroup Medicaid |
$33,957.82
|
| 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 |
$33,628.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34,122.67
|
|
|
Revision of Hip or Knee Replacement Without CC/MCC
|
Facility
IP
|
$27,178.84
|
|
|
Service Code
|
MS-DRG 468
|
| Hospital Charge Code |
288
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$27,178.84 |
| Rate for Payer: Amerigroup Medicaid |
$27,047.54
|
| 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 |
$26,784.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27,178.84
|
|
