|
SPIKED GRIDLOCK ANKLE WASHER
|
Facility
OP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8780887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.44
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$144.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$143.94
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$144.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$146.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
SPIKED GRIDLOCK ANKLE WASHER
|
Facility
IP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8780887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
|
|
SPIKED GRIDLOCK SCREW WASHER LARGE
|
Facility
IP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8740441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
|
|
SPIKED GRIDLOCK SCREW WASHER LARGE
|
Facility
OP
|
$288.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8740441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$143.94 |
| Max. Negotiated Rate |
$259.20 |
| Rate for Payer: Aetna of IA Commercial |
$259.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$259.20
|
| Rate for Payer: Aetna of IA Medicare |
$164.16
|
| Rate for Payer: Amerigroup Medicaid |
$145.35
|
| Rate for Payer: Amerigroup Medicare |
$145.44
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$216.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$144.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$143.94
|
| Rate for Payer: Medical Associates Commercial |
$216.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$144.00
|
| Rate for Payer: Midlands Choice Commercial |
$201.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$146.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Commercial |
$259.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$169.92
|
|
|
SPIKED WASHER 4.5MM
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8897829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
SPIKED WASHER 4.5MM
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8897829
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$67.47 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
|
|
SPIKED WASHER FOR 4.5 SCREW
|
Facility
IP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
|
|
SPIKED WASHER FOR 4.5 SCREW
|
Facility
OP
|
$180.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8047046
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.96 |
| Max. Negotiated Rate |
$162.00 |
| Rate for Payer: Aetna of IA Commercial |
$162.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$162.00
|
| Rate for Payer: Aetna of IA Medicare |
$102.60
|
| Rate for Payer: Amerigroup Medicaid |
$90.85
|
| Rate for Payer: Amerigroup Medicare |
$90.90
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$135.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$90.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$89.96
|
| Rate for Payer: Medical Associates Commercial |
$135.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$90.00
|
| Rate for Payer: Midlands Choice Commercial |
$126.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$91.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$162.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$106.20
|
|
|
SPINAL ANESTHESIA I
|
Facility
OP
|
$789.00
|
|
| Hospital Charge Code |
8059078
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$394.34 |
| Max. Negotiated Rate |
$710.10 |
| Rate for Payer: Aetna of IA Commercial |
$710.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$710.10
|
| Rate for Payer: Aetna of IA Medicare |
$449.73
|
| Rate for Payer: Amerigroup Medicaid |
$398.21
|
| Rate for Payer: Amerigroup Medicare |
$398.44
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$591.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$394.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$394.34
|
| Rate for Payer: Medical Associates Commercial |
$591.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$394.50
|
| Rate for Payer: Midlands Choice Commercial |
$552.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$400.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$591.75
|
| Rate for Payer: United Healthcare Commercial |
$710.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$465.51
|
|
|
SPINAL ANESTHESIA I
|
Facility
IP
|
$789.00
|
|
| Hospital Charge Code |
8059078
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$552.30 |
| Max. Negotiated Rate |
$710.10 |
| Rate for Payer: Aetna of IA Commercial |
$710.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$710.10
|
| Rate for Payer: Cash Price |
$631.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$591.75
|
| Rate for Payer: Medical Associates Commercial |
$591.75
|
| Rate for Payer: Midlands Choice Commercial |
$552.30
|
| Rate for Payer: United Healthcare Commercial |
$710.10
|
|
|
SPINAL ANESTHESIA II
|
Facility
IP
|
$958.00
|
|
| Hospital Charge Code |
8059590
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$670.60 |
| Max. Negotiated Rate |
$862.20 |
| Rate for Payer: Aetna of IA Commercial |
$862.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$862.20
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$718.50
|
| Rate for Payer: Medical Associates Commercial |
$718.50
|
| Rate for Payer: Midlands Choice Commercial |
$670.60
|
| Rate for Payer: United Healthcare Commercial |
$862.20
|
|
|
SPINAL ANESTHESIA II
|
Facility
OP
|
$958.00
|
|
| Hospital Charge Code |
8059590
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$478.81 |
| Max. Negotiated Rate |
$862.20 |
| Rate for Payer: Aetna of IA Commercial |
$862.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$862.20
|
| Rate for Payer: Aetna of IA Medicare |
$546.06
|
| Rate for Payer: Amerigroup Medicaid |
$483.50
|
| Rate for Payer: Amerigroup Medicare |
$483.79
|
| Rate for Payer: Cash Price |
$766.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$718.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$479.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$478.81
|
| Rate for Payer: Medical Associates Commercial |
$718.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$479.00
|
| Rate for Payer: Midlands Choice Commercial |
$670.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$486.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$718.50
|
| Rate for Payer: United Healthcare Commercial |
$862.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$565.22
|
|
|
SPINAL ANESTHESIA III
|
Facility
IP
|
$459.00
|
|
| Hospital Charge Code |
8059079
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$321.30 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of IA Commercial |
$413.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$413.10
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$344.25
|
| Rate for Payer: Medical Associates Commercial |
$344.25
|
| Rate for Payer: Midlands Choice Commercial |
$321.30
|
| Rate for Payer: United Healthcare Commercial |
$413.10
|
|
|
SPINAL ANESTHESIA III
|
Facility
OP
|
$459.00
|
|
| Hospital Charge Code |
8059079
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$229.41 |
| Max. Negotiated Rate |
$413.10 |
| Rate for Payer: Aetna of IA Commercial |
$413.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$413.10
|
| Rate for Payer: Aetna of IA Medicare |
$261.63
|
| Rate for Payer: Amerigroup Medicaid |
$231.66
|
| Rate for Payer: Amerigroup Medicare |
$231.80
|
| Rate for Payer: Cash Price |
$367.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$344.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$229.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$229.41
|
| Rate for Payer: Medical Associates Commercial |
$344.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$229.50
|
| Rate for Payer: Midlands Choice Commercial |
$321.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$232.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$344.25
|
| Rate for Payer: United Healthcare Commercial |
$413.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$270.81
|
|
|
Spinal Disorders and Injuries With CC/MCC
|
Facility
IP
|
$16,426.99
|
|
|
Service Code
|
MS-DRG 052
|
| Hospital Charge Code |
732
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,426.99 |
| Rate for Payer: Amerigroup Medicaid |
$16,347.63
|
| 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 |
$16,188.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,426.99
|
|
|
Spinal Disorders and Injuries Without CC/MCC
|
Facility
IP
|
$11,184.92
|
|
|
Service Code
|
MS-DRG 053
|
| Hospital Charge Code |
733
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,184.92 |
| Rate for Payer: Amerigroup Medicaid |
$11,130.89
|
| 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 |
$11,022.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,184.92
|
|
|
SPINAL FLUID TAP DIAGNOSTIC
|
Professional
|
$526.00
|
|
|
Service Code
|
CPT 62270
|
| Hospital Charge Code |
7982766
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$56.25 |
| Max. Negotiated Rate |
$368.20 |
| Rate for Payer: Aetna of IA Medicare |
$56.25
|
| Rate for Payer: Amerigroup Medicaid |
$58.16
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Cash Price |
$420.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.38
|
| Rate for Payer: Medical Associates Commercial |
$106.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$368.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$84.38
|
| Rate for Payer: Wellmark IA HMO |
$111.00
|
| Rate for Payer: Wellmark IA PPO |
$131.00
|
|
|
Spinal Fusion Except Cervical With MCC
|
Facility
IP
|
$46,561.51
|
|
|
Service Code
|
MS-DRG 459
|
| Hospital Charge Code |
279
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$46,561.51 |
| Rate for Payer: Amerigroup Medicaid |
$46,336.58
|
| 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 |
$45,886.71
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46,561.51
|
|
|
Spinal Fusion Except Cervical Without MCC
|
Facility
IP
|
$30,898.29
|
|
|
Service Code
|
MS-DRG 460
|
| Hospital Charge Code |
280
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$30,898.29 |
| Rate for Payer: Amerigroup Medicaid |
$30,749.02
|
| 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 |
$30,450.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30,898.29
|
|
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection or Extensive Fusions With CC
|
Facility
IP
|
$52,614.60
|
|
|
Service Code
|
MS-DRG 457
|
| Hospital Charge Code |
277
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$52,614.60 |
| Rate for Payer: Amerigroup Medicaid |
$52,360.42
|
| 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 |
$51,852.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52,614.60
|
|
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection or Extensive Fusions With MCC
|
Facility
IP
|
$71,214.80
|
|
|
Service Code
|
MS-DRG 456
|
| Hospital Charge Code |
276
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$71,214.80 |
| Rate for Payer: Amerigroup Medicaid |
$70,870.77
|
| 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 |
$70,182.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71,214.80
|
|
|
Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection or Extensive Fusions Without CC/MCC
|
Facility
IP
|
$51,718.94
|
|
|
Service Code
|
MS-DRG 458
|
| Hospital Charge Code |
278
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$51,718.94 |
| Rate for Payer: Amerigroup Medicaid |
$51,469.09
|
| 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 |
$50,969.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51,718.94
|
|
|
Spinal injection- lumbar w/o imaging
|
Professional
|
$517.00
|
|
|
Service Code
|
CPT 62322
|
| Hospital Charge Code |
8037762
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$72.43 |
| Max. Negotiated Rate |
$361.90 |
| Rate for Payer: Aetna of IA Medicare |
$72.43
|
| Rate for Payer: Amerigroup Medicaid |
$74.89
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.88
|
| Rate for Payer: Medical Associates Commercial |
$137.62
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.43
|
| Rate for Payer: Midlands Choice Commercial |
$361.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$108.64
|
| Rate for Payer: Wellmark IA HMO |
$142.00
|
| Rate for Payer: Wellmark IA PPO |
$167.00
|
|
|
Spinal Procedures With CC or Spinal Neurostimulators
|
Facility
IP
|
$21,499.78
|
|
|
Service Code
|
MS-DRG 029
|
| Hospital Charge Code |
718
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$21,499.78 |
| Rate for Payer: Amerigroup Medicaid |
$21,395.91
|
| 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 |
$21,188.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21,499.78
|
|
|
Spinal Procedures With MCC
|
Facility
IP
|
$36,436.63
|
|
|
Service Code
|
MS-DRG 028
|
| Hospital Charge Code |
717
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$36,436.63 |
| Rate for Payer: Amerigroup Medicaid |
$36,260.60
|
| 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 |
$35,908.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36,436.63
|
|
