|
Antiphospholipid Antibody Profile DMCL
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
8037498
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Aetna of IA Medicare |
$36.48
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$32.32
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.76
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
Antiphospholipid Antibody Profile DMCL
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
8037498
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Aetna of IA Commercial |
$57.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.60
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.00
|
| Rate for Payer: Medical Associates Commercial |
$48.00
|
| Rate for Payer: Midlands Choice Commercial |
$44.80
|
| Rate for Payer: United Healthcare Commercial |
$57.60
|
|
|
ANTIPLATELET ANTIBODY
|
Facility
OP
|
$175.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
8093925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Aetna of IA Medicare |
$99.75
|
| Rate for Payer: Amerigroup Medicaid |
$88.32
|
| Rate for Payer: Amerigroup Medicare |
$88.38
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$87.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.46
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$87.50
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$88.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$131.25
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$103.25
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
ANTIPLATELET ANTIBODY
|
Facility
IP
|
$175.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
8093925
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of IA Commercial |
$157.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$157.50
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$131.25
|
| Rate for Payer: Medical Associates Commercial |
$131.25
|
| Rate for Payer: Midlands Choice Commercial |
$122.50
|
| Rate for Payer: United Healthcare Commercial |
$157.50
|
|
|
Antistreptolysin O DMCL
|
Facility
OP
|
$70.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
8037499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Aetna of IA Medicare |
$39.90
|
| Rate for Payer: Amerigroup Medicaid |
$35.33
|
| Rate for Payer: Amerigroup Medicare |
$35.35
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.99
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.00
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$52.50
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.30
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Antistreptolysin O DMCL
|
Facility
IP
|
$70.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
8037499
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna of IA Commercial |
$63.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$52.50
|
| Rate for Payer: Medical Associates Commercial |
$52.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.00
|
| Rate for Payer: United Healthcare Commercial |
$63.00
|
|
|
Anti-Thrombin Antigen DMCL
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
8037482
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$72.10 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
|
|
Anti-Thrombin Antigen DMCL
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
8037482
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna of IA Commercial |
$92.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$92.70
|
| Rate for Payer: Aetna of IA Medicare |
$58.71
|
| Rate for Payer: Amerigroup Medicaid |
$51.98
|
| Rate for Payer: Amerigroup Medicare |
$52.02
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$77.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$51.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.48
|
| Rate for Payer: Medical Associates Commercial |
$77.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$51.50
|
| Rate for Payer: Midlands Choice Commercial |
$72.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.27
|
| Rate for Payer: Partners Health Alliance Commercial |
$77.25
|
| Rate for Payer: United Healthcare Commercial |
$92.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$60.77
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
Anti Xa Heparin UFH DMCL
|
Facility
IP
|
$58.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
8818432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
Anti Xa Heparin UFH DMCL
|
Facility
OP
|
$58.00
|
|
|
Service Code
|
CPT 85335
|
| Hospital Charge Code |
8818432
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$29.27
|
| Rate for Payer: Amerigroup Medicare |
$29.29
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.99
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO |
$24.18
|
| Rate for Payer: Wellmark IA PPO |
$26.60
|
|
|
Aortic and Heart Assist Procedures Except Pulsation Balloon With MCC
|
Facility
IP
|
$51,371.50
|
|
|
Service Code
|
MS-DRG 268
|
| Hospital Charge Code |
130
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$51,371.50 |
| Rate for Payer: Amerigroup Medicaid |
$51,123.33
|
| 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 |
$50,626.99
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$51,371.50
|
|
|
Aortic and Heart Assist Procedures Except Pulsation Balloon Without MCC
|
Facility
IP
|
$29,227.05
|
|
|
Service Code
|
MS-DRG 269
|
| Hospital Charge Code |
131
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$29,227.05 |
| Rate for Payer: Amerigroup Medicaid |
$29,085.86
|
| 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 |
$28,803.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29,227.05
|
|
|
APAP/butalbital/caffeine 325 MG-50 MG-40 MG
|
Facility
OP
|
$1.54
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna of IA Commercial |
$1.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.39
|
| Rate for Payer: Aetna of IA Medicare |
$0.88
|
| Rate for Payer: Amerigroup Medicaid |
$0.78
|
| Rate for Payer: Amerigroup Medicare |
$0.78
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.77
|
| Rate for Payer: Medical Associates Commercial |
$1.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.77
|
| Rate for Payer: Midlands Choice Commercial |
$1.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.91
|
|
|
APAP/butalbital/caffeine 325 MG-50 MG-40 MG
|
Facility
IP
|
$1.54
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700143
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.39 |
| Rate for Payer: Aetna of IA Commercial |
$1.39
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.39
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.16
|
| Rate for Payer: Medical Associates Commercial |
$1.16
|
| Rate for Payer: Midlands Choice Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.39
|
|
|
apixaban 5 mg Tab UD
|
Facility
IP
|
$28.34
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.84 |
| Max. Negotiated Rate |
$25.51 |
| Rate for Payer: Aetna of IA Commercial |
$25.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.51
|
| Rate for Payer: Cash Price |
$22.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.26
|
| Rate for Payer: Medical Associates Commercial |
$21.26
|
| Rate for Payer: Midlands Choice Commercial |
$19.84
|
| Rate for Payer: United Healthcare Commercial |
$25.51
|
|
|
apixaban 5 mg Tab UD
|
Facility
OP
|
$28.34
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700332
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.16 |
| Max. Negotiated Rate |
$25.51 |
| Rate for Payer: Aetna of IA Commercial |
$25.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.51
|
| Rate for Payer: Aetna of IA Medicare |
$16.15
|
| Rate for Payer: Amerigroup Medicaid |
$14.30
|
| Rate for Payer: Amerigroup Medicare |
$14.31
|
| Rate for Payer: Cash Price |
$22.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$21.26
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.17
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.16
|
| Rate for Payer: Medical Associates Commercial |
$21.26
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.17
|
| Rate for Payer: Midlands Choice Commercial |
$19.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$21.26
|
| Rate for Payer: United Healthcare Commercial |
$25.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.72
|
|
|
Apolipoprotein B DMCL
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
8938406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna of IA Commercial |
$67.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.50
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.25
|
| Rate for Payer: Medical Associates Commercial |
$56.25
|
| Rate for Payer: Midlands Choice Commercial |
$52.50
|
| Rate for Payer: United Healthcare Commercial |
$67.50
|
|
|
Apolipoprotein B DMCL
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
8938406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$37.48 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Aetna of IA Commercial |
$67.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.50
|
| Rate for Payer: Aetna of IA Medicare |
$42.75
|
| Rate for Payer: Amerigroup Medicaid |
$37.85
|
| Rate for Payer: Amerigroup Medicare |
$37.88
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.48
|
| Rate for Payer: Medical Associates Commercial |
$56.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.50
|
| Rate for Payer: Midlands Choice Commercial |
$52.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.25
|
| Rate for Payer: United Healthcare Commercial |
$67.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.25
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Appendectomy With Complicated Principal Diagnosis With CC
|
Facility
IP
|
$15,202.60
|
|
|
Service Code
|
MS-DRG 339
|
| Hospital Charge Code |
189
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,202.60 |
| Rate for Payer: Amerigroup Medicaid |
$15,129.16
|
| 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 |
$14,982.27
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,202.60
|
|
|
Appendectomy With Complicated Principal Diagnosis With MCC
|
Facility
IP
|
$16,452.58
|
|
|
Service Code
|
MS-DRG 338
|
| Hospital Charge Code |
188
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,452.58 |
| Rate for Payer: Amerigroup Medicaid |
$16,373.10
|
| 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 |
$16,214.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,452.58
|
|
|
Appendectomy With Complicated Principal Diagnosis Without CC/MCC
|
Facility
IP
|
$10,637.68
|
|
|
Service Code
|
MS-DRG 340
|
| Hospital Charge Code |
190
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,637.68 |
| Rate for Payer: Amerigroup Medicaid |
$10,586.29
|
| 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 |
$10,483.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,637.68
|
|
|
Appendectomy Without Complicated Principal Diagnosis With CC
|
Facility
IP
|
$11,349.29
|
|
|
Service Code
|
MS-DRG 342
|
| Hospital Charge Code |
192
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$11,349.29 |
| Rate for Payer: Amerigroup Medicaid |
$11,294.46
|
| 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 |
$11,184.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,349.29
|
|
|
Appendectomy Without Complicated Principal Diagnosis With MCC
|
Facility
IP
|
$15,920.11
|
|
|
Service Code
|
MS-DRG 341
|
| Hospital Charge Code |
191
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,920.11 |
| Rate for Payer: Amerigroup Medicaid |
$15,843.20
|
| 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 |
$15,689.38
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,920.11
|
|
|
Appendectomy Without Complicated Principal Diagnosis Without CC/MCC
|
Facility
IP
|
$8,414.28
|
|
|
Service Code
|
MS-DRG 343
|
| Hospital Charge Code |
193
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,414.28 |
| Rate for Payer: Amerigroup Medicaid |
$8,373.63
|
| 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 |
$8,292.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,414.28
|
|
|
APPLICATION LONG LEG SPLINT
|
Professional
|
$218.00
|
|
|
Service Code
|
CPT 29505
|
| Hospital Charge Code |
7982786
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$47.41 |
| Max. Negotiated Rate |
$152.60 |
| Rate for Payer: Aetna of IA Medicare |
$47.41
|
| Rate for Payer: Amerigroup Medicaid |
$49.02
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.36
|
| Rate for Payer: Medical Associates Commercial |
$90.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.41
|
| Rate for Payer: Midlands Choice Commercial |
$152.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.12
|
| Rate for Payer: Wellmark IA HMO |
$99.00
|
| Rate for Payer: Wellmark IA PPO |
$116.00
|
|
