|
carbidopa-levodopa 25 mg-100 mg Tab
|
Facility
IP
|
$1.55
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| Rate for Payer: Cash Price |
$1.24
|
| 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 |
$1.40
|
|
|
carbidopa-levodopa 25 mg-100 mg Tab
|
Facility
OP
|
$1.55
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: Aetna of IA Commercial |
$1.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.40
|
| 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 |
$1.24
|
| 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 |
$0.78
|
| 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 |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$1.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.91
|
|
|
carbidopa-levodopa 25 mg-250 mg Tab
|
Facility
OP
|
$1.79
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702592
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Aetna of IA Medicare |
$1.02
|
| Rate for Payer: Amerigroup Medicaid |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.90
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.06
|
|
|
carbidopa-levodopa 25 mg-250 mg Tab
|
Facility
IP
|
$1.79
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702592
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
|
|
CARBON DIOXIDE LEVEL
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
1628888
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Aetna of IA Medicare |
$25.08
|
| Rate for Payer: Amerigroup Medicaid |
$22.21
|
| Rate for Payer: Amerigroup Medicare |
$22.22
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$21.99
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$25.96
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
CARBON DIOXIDE LEVEL
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
1628888
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$39.60 |
| Rate for Payer: Aetna of IA Commercial |
$39.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$39.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.00
|
| Rate for Payer: Medical Associates Commercial |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$30.80
|
| Rate for Payer: United Healthcare Commercial |
$39.60
|
|
|
CARBOplatin 10 mg/mL Sol 45 ml MDV
|
Facility
IP
|
$136.00
|
|
|
Service Code
|
CPT J9045
|
| Hospital Charge Code |
43706699
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Aetna of IA Commercial |
$122.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$122.40
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.00
|
| Rate for Payer: Medical Associates Commercial |
$102.00
|
| Rate for Payer: Midlands Choice Commercial |
$95.20
|
| Rate for Payer: United Healthcare Commercial |
$122.40
|
|
|
CARBOplatin 10 mg/mL Sol 45 ml MDV
|
Facility
OP
|
$136.00
|
|
|
Service Code
|
CPT J9045
|
| Hospital Charge Code |
43706699
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Aetna of IA Commercial |
$122.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$122.40
|
| Rate for Payer: Aetna of IA Medicare |
$77.52
|
| Rate for Payer: Amerigroup Medicaid |
$68.64
|
| Rate for Payer: Amerigroup Medicare |
$68.68
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$68.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.97
|
| Rate for Payer: Medical Associates Commercial |
$102.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$68.00
|
| Rate for Payer: Midlands Choice Commercial |
$95.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$69.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.00
|
| Rate for Payer: United Healthcare Commercial |
$122.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$80.24
|
|
|
CARBOXYHEMOGLOBIN
|
Facility
IP
|
$117.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
7928765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
|
|
CARBOXYHEMOGLOBIN
|
Facility
OP
|
$117.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
7928765
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Aetna of IA Medicare |
$66.69
|
| Rate for Payer: Amerigroup Medicaid |
$59.05
|
| Rate for Payer: Amerigroup Medicare |
$59.08
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.48
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.03
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Carboxyhemoglobin Venous
|
Facility
IP
|
$117.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
8208908
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
|
|
Carboxyhemoglobin Venous
|
Facility
OP
|
$117.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
8208908
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Aetna of IA Medicare |
$66.69
|
| Rate for Payer: Amerigroup Medicaid |
$59.05
|
| Rate for Payer: Amerigroup Medicare |
$59.08
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.48
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.03
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Carcinoembryonic Antigen DMCL
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
8037509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
Carcinoembryonic Antigen DMCL
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
8037509
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$65.11
|
| Rate for Payer: Amerigroup Medicare |
$65.14
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.47
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Cardiac Arrest, Unexplained With CC
|
Facility
IP
|
$6,936.93
|
|
|
Service Code
|
MS-DRG 297
|
| Hospital Charge Code |
154
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,936.93 |
| Rate for Payer: Amerigroup Medicaid |
$6,903.42
|
| 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 |
$6,836.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,936.93
|
|
|
Cardiac Arrest, Unexplained With MCC
|
Facility
IP
|
$12,170.15
|
|
|
Service Code
|
MS-DRG 296
|
| Hospital Charge Code |
153
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$12,170.15 |
| Rate for Payer: Amerigroup Medicaid |
$12,111.36
|
| 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 |
$11,993.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,170.15
|
|
|
Cardiac Arrest, Unexplained Without CC/MCC
|
Facility
IP
|
$4,805.07
|
|
|
Service Code
|
MS-DRG 298
|
| Hospital Charge Code |
155
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$4,805.07 |
| Rate for Payer: Amerigroup Medicaid |
$4,781.86
|
| 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 |
$4,735.43
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,805.07
|
|
|
Cardiac Arrhythmia and Conduction Disorders With CC
|
Facility
IP
|
$6,077.70
|
|
|
Service Code
|
MS-DRG 309
|
| Hospital Charge Code |
166
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,077.70 |
| Rate for Payer: Amerigroup Medicaid |
$6,048.34
|
| 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 |
$5,989.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,077.70
|
|
|
Cardiac Arrhythmia and Conduction Disorders With MCC
|
Facility
IP
|
$8,927.07
|
|
|
Service Code
|
MS-DRG 308
|
| Hospital Charge Code |
165
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$8,927.07 |
| Rate for Payer: Amerigroup Medicaid |
$8,883.95
|
| 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 |
$8,797.69
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,927.07
|
|
|
Cardiac Arrhythmia and Conduction Disorders Without CC/MCC
|
Facility
IP
|
$4,773.58
|
|
|
Service Code
|
MS-DRG 310
|
| Hospital Charge Code |
167
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$4,773.58 |
| Rate for Payer: Amerigroup Medicaid |
$4,750.51
|
| 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 |
$4,704.39
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4,773.58
|
|
|
Cardiac Congenital and Valvular Disorders With MCC
|
Facility
IP
|
$18,357.09
|
|
|
Service Code
|
MS-DRG 306
|
| Hospital Charge Code |
163
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$18,357.09 |
| Rate for Payer: Amerigroup Medicaid |
$18,268.41
|
| 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 |
$18,091.05
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,357.09
|
|
|
Cardiac Congenital and Valvular Disorders Without MCC
|
Facility
IP
|
$7,487.13
|
|
|
Service Code
|
MS-DRG 307
|
| Hospital Charge Code |
164
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,487.13 |
| Rate for Payer: Amerigroup Medicaid |
$7,450.96
|
| 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 |
$7,378.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,487.13
|
|
|
Cardiac Defibrillator Implant With Cardiac Catheterization With AMI, Hf or Shock With MCC
|
Facility
IP
|
$73,235.44
|
|
|
Service Code
|
MS-DRG 222
|
| Hospital Charge Code |
87
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$73,235.44 |
| Rate for Payer: Amerigroup Medicaid |
$72,881.65
|
| 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 |
$72,174.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73,235.44
|
|
|
Cardiac Defibrillator Implant With Cardiac Catheterization With AMI, Hf or Shock Without MCC
|
Facility
IP
|
$45,700.30
|
|
|
Service Code
|
MS-DRG 223
|
| Hospital Charge Code |
88
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$45,700.30 |
| Rate for Payer: Amerigroup Medicaid |
$45,479.53
|
| 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 |
$45,037.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$45,700.30
|
|
|
Cardiac Defibrillator Implant With Cardiac Catheterization Without AMI, Hf or Shock With MCC
|
Facility
IP
|
$79,337.74
|
|
|
Service Code
|
MS-DRG 224
|
| Hospital Charge Code |
89
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$79,337.74 |
| Rate for Payer: Amerigroup Medicaid |
$78,954.46
|
| 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 |
$78,187.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79,337.74
|
|
