|
Seizures Without MCC
|
Facility
IP
|
$5,309.00
|
|
|
Service Code
|
MS-DRG 101
|
| Hospital Charge Code |
2
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,309.00 |
| Rate for Payer: Amerigroup Medicaid |
$5,283.35
|
| 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 |
$5,232.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,309.00
|
|
|
SELECTIVE DEBRIDEMENT EA ADD'L 20 SQ CM
|
Professional
|
$207.00
|
|
|
Service Code
|
CPT 97598
|
| Hospital Charge Code |
8068909
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$22.35 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Medicare |
$22.35
|
| Rate for Payer: Amerigroup Medicaid |
$23.11
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22.80
|
| Rate for Payer: Medical Associates Commercial |
$42.46
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.35
|
| Rate for Payer: Midlands Choice Commercial |
$144.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.52
|
| Rate for Payer: Wellmark IA HMO |
$35.00
|
| Rate for Payer: Wellmark IA PPO |
$35.00
|
|
|
SELECTIVE DEBRIDEMENT FIRST 20 SQ CM
|
Facility
IP
|
$266.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
7440831
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.20 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Aetna of IA Commercial |
$239.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$239.40
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$199.50
|
| Rate for Payer: Medical Associates Commercial |
$199.50
|
| Rate for Payer: Midlands Choice Commercial |
$186.20
|
| Rate for Payer: United Healthcare Commercial |
$239.40
|
|
|
SELECTIVE DEBRIDEMENT FIRST 20 SQ CM
|
Facility
OP
|
$266.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
7440831
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.95 |
| Max. Negotiated Rate |
$598.11 |
| Rate for Payer: Aetna of IA Commercial |
$239.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$239.40
|
| Rate for Payer: Aetna of IA Medicare |
$151.62
|
| Rate for Payer: Amerigroup Medicaid |
$134.25
|
| Rate for Payer: Amerigroup Medicare |
$134.33
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$199.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$133.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$132.95
|
| Rate for Payer: Medical Associates Commercial |
$199.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$133.00
|
| Rate for Payer: Midlands Choice Commercial |
$186.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$135.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$239.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$156.94
|
| Rate for Payer: Wellmark IA HMO |
$543.74
|
| Rate for Payer: Wellmark IA PPO |
$598.11
|
|
|
SEMEN VASECTOMY
|
Facility
OP
|
$74.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
3527268
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$36.99 |
| Max. Negotiated Rate |
$67.52 |
| Rate for Payer: Aetna of IA Commercial |
$66.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.60
|
| Rate for Payer: Aetna of IA Medicare |
$42.18
|
| Rate for Payer: Amerigroup Medicaid |
$37.35
|
| Rate for Payer: Amerigroup Medicare |
$37.37
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.99
|
| Rate for Payer: Medical Associates Commercial |
$55.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.00
|
| Rate for Payer: Midlands Choice Commercial |
$51.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.50
|
| Rate for Payer: United Healthcare Commercial |
$66.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.66
|
| Rate for Payer: Wellmark IA HMO |
$61.38
|
| Rate for Payer: Wellmark IA PPO |
$67.52
|
|
|
SEMEN VASECTOMY
|
Facility
IP
|
$74.00
|
|
|
Service Code
|
CPT 89321
|
| Hospital Charge Code |
3527268
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$66.60 |
| Rate for Payer: Aetna of IA Commercial |
$66.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.60
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.50
|
| Rate for Payer: Medical Associates Commercial |
$55.50
|
| Rate for Payer: Midlands Choice Commercial |
$51.80
|
| Rate for Payer: United Healthcare Commercial |
$66.60
|
|
|
senna 8.6 mg Tab
|
Facility
OP
|
$1.12
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Aetna of IA Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicaid |
$0.57
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.56
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.56
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.66
|
|
|
senna 8.6 mg Tab
|
Facility
IP
|
$1.12
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700251
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$1.01 |
| Rate for Payer: Aetna of IA Commercial |
$1.01
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.01
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.84
|
| Rate for Payer: Medical Associates Commercial |
$0.84
|
| Rate for Payer: Midlands Choice Commercial |
$0.78
|
| Rate for Payer: United Healthcare Commercial |
$1.01
|
|
|
senna-docusate-8.6 mg-50 mg Tab
|
Facility
IP
|
$1.38
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Aetna of IA Commercial |
$1.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.24
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.04
|
| Rate for Payer: Medical Associates Commercial |
$1.04
|
| Rate for Payer: Midlands Choice Commercial |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
|
|
senna-docusate-8.6 mg-50 mg Tab
|
Facility
OP
|
$1.38
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.24 |
| Rate for Payer: Aetna of IA Commercial |
$1.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.24
|
| Rate for Payer: Aetna of IA Medicare |
$0.79
|
| Rate for Payer: Amerigroup Medicaid |
$0.70
|
| Rate for Payer: Amerigroup Medicare |
$0.70
|
| Rate for Payer: Cash Price |
$1.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.69
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.69
|
| Rate for Payer: Medical Associates Commercial |
$1.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.69
|
| Rate for Payer: Midlands Choice Commercial |
$0.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.24
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.81
|
|
|
SENSITIVITY
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4210782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
SENSITIVITY
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4210782
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
SENSITIVITY
|
Facility
OP
|
$71.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
294946
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$31.00 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
SENSITIVITY
|
Facility
IP
|
$71.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
294946
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
SENSORY INTEGRATION/15 MIN
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GO
|
| Hospital Charge Code |
1373568
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Aetna of IA Medicare |
$87.21
|
| Rate for Payer: Amerigroup Medicaid |
$77.22
|
| Rate for Payer: Amerigroup Medicare |
$77.26
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$76.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.47
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.50
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.75
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$90.27
|
|
|
SENSORY INTEGRATION/15 MIN
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GO
|
| Hospital Charge Code |
1373568
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
|
|
SENSORY INTEGRATIVE 15 MIN
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GN
|
| Hospital Charge Code |
1373955
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
|
|
SENSORY INTEGRATIVE 15 MIN
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 97533 GN
|
| Hospital Charge Code |
1373955
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Aetna of IA Commercial |
$137.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$137.70
|
| Rate for Payer: Aetna of IA Medicare |
$87.21
|
| Rate for Payer: Amerigroup Medicaid |
$77.22
|
| Rate for Payer: Amerigroup Medicare |
$77.26
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$114.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$76.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$76.47
|
| Rate for Payer: Medical Associates Commercial |
$114.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$76.50
|
| Rate for Payer: Midlands Choice Commercial |
$107.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$77.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.75
|
| Rate for Payer: United Healthcare Commercial |
$137.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$90.27
|
|
|
Septic Arthritis With CC
|
Facility
IP
|
$8,499.91
|
|
|
Service Code
|
MS-DRG 549
|
| Hospital Charge Code |
356
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,499.91 |
| Rate for Payer: Amerigroup Medicaid |
$8,458.84
|
| 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 |
$8,376.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,499.91
|
|
|
Septic Arthritis With MCC
|
Facility
IP
|
$19,981.09
|
|
|
Service Code
|
MS-DRG 548
|
| Hospital Charge Code |
355
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$19,981.09 |
| Rate for Payer: Amerigroup Medicaid |
$19,884.56
|
| 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 |
$19,691.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,981.09
|
|
|
Septic Arthritis Without CC/MCC
|
Facility
IP
|
$8,499.91
|
|
|
Service Code
|
MS-DRG 550
|
| Hospital Charge Code |
357
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,499.91 |
| Rate for Payer: Amerigroup Medicaid |
$8,458.84
|
| 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 |
$8,376.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,499.91
|
|
|
Septicemia or Severe Sepsis With MV >96 Hours
|
Facility
IP
|
$61,769.03
|
|
|
Service Code
|
MS-DRG 870
|
| Hospital Charge Code |
606
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$61,769.03 |
| Rate for Payer: Amerigroup Medicaid |
$61,470.63
|
| 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 |
$60,873.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61,769.03
|
|
|
Septicemia or Severe Sepsis Without MV >96 Hours With MCC
|
Facility
IP
|
$14,208.51
|
|
|
Service Code
|
MS-DRG 871
|
| Hospital Charge Code |
607
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,208.51 |
| Rate for Payer: Amerigroup Medicaid |
$14,139.87
|
| 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 |
$14,002.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,208.51
|
|
|
Septicemia or Severe Sepsis Without MV >96 Hours Without MCC
|
Facility
IP
|
$7,838.50
|
|
|
Service Code
|
MS-DRG 872
|
| Hospital Charge Code |
608
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,838.50 |
| Rate for Payer: Amerigroup Medicaid |
$7,800.63
|
| 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 |
$7,724.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,838.50
|
|
|
sertraline 50 mg Tab
|
Facility
IP
|
$1.90
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701418
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna of IA Commercial |
$1.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.71
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.42
|
| Rate for Payer: Medical Associates Commercial |
$1.42
|
| Rate for Payer: Midlands Choice Commercial |
$1.33
|
| Rate for Payer: United Healthcare Commercial |
$1.71
|
|
