|
CHLORIDE LEVEL
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
633621
|
|
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
|
|
|
chloroprocaine 10 mg/mL 5ml SDV
|
Facility
IP
|
$75.47
|
|
|
Service Code
|
CPT J2400
|
| Hospital Charge Code |
43700447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.83 |
| Max. Negotiated Rate |
$67.92 |
| Rate for Payer: Midlands Choice Commercial |
$52.83
|
| Rate for Payer: United Healthcare Commercial |
$67.92
|
| Rate for Payer: Aetna of IA Commercial |
$67.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.92
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.60
|
| Rate for Payer: Medical Associates Commercial |
$56.60
|
|
|
chloroprocaine 10 mg/mL 5ml SDV
|
Facility
OP
|
$75.47
|
|
|
Service Code
|
CPT J2400
|
| Hospital Charge Code |
43700447
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.72 |
| Max. Negotiated Rate |
$67.92 |
| Rate for Payer: Aetna of IA Commercial |
$67.92
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.92
|
| Rate for Payer: Aetna of IA Medicare |
$43.02
|
| Rate for Payer: Amerigroup Medicaid |
$38.09
|
| Rate for Payer: Amerigroup Medicare |
$38.11
|
| Rate for Payer: Cash Price |
$60.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$56.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.72
|
| Rate for Payer: Medical Associates Commercial |
$56.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.74
|
| Rate for Payer: Midlands Choice Commercial |
$52.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.60
|
| Rate for Payer: United Healthcare Commercial |
$67.92
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.53
|
|
|
chloroprocaine 1% MDV 300mg/30ml
|
Facility
IP
|
$80.08
|
|
|
Service Code
|
CPT J2400
|
| Hospital Charge Code |
43700496
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$72.07 |
| Rate for Payer: Aetna of IA Commercial |
$72.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$72.07
|
| Rate for Payer: Cash Price |
$64.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.06
|
| Rate for Payer: Medical Associates Commercial |
$60.06
|
| Rate for Payer: Midlands Choice Commercial |
$56.06
|
| Rate for Payer: United Healthcare Commercial |
$72.07
|
|
|
chloroprocaine 1% MDV 300mg/30ml
|
Facility
OP
|
$80.08
|
|
|
Service Code
|
CPT J2400
|
| Hospital Charge Code |
43700496
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.02 |
| Max. Negotiated Rate |
$72.07 |
| Rate for Payer: Aetna of IA Commercial |
$72.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$72.07
|
| Rate for Payer: Aetna of IA Medicare |
$45.65
|
| Rate for Payer: Amerigroup Medicaid |
$40.42
|
| Rate for Payer: Amerigroup Medicare |
$40.44
|
| Rate for Payer: Cash Price |
$64.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$40.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.02
|
| Rate for Payer: Medical Associates Commercial |
$60.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.04
|
| Rate for Payer: Midlands Choice Commercial |
$56.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.06
|
| Rate for Payer: United Healthcare Commercial |
$72.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$47.25
|
|
|
chloroprocaine 3% PF 600mg/20ml SDV
|
Facility
IP
|
$69.29
|
|
|
Service Code
|
CPT J2400
|
| Hospital Charge Code |
43700501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.50 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna of IA Commercial |
$62.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.36
|
| Rate for Payer: Cash Price |
$55.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.97
|
| Rate for Payer: Medical Associates Commercial |
$51.97
|
| Rate for Payer: Midlands Choice Commercial |
$48.50
|
| Rate for Payer: United Healthcare Commercial |
$62.36
|
|
|
chloroprocaine 3% PF 600mg/20ml SDV
|
Facility
OP
|
$69.29
|
|
|
Service Code
|
CPT J2400
|
| Hospital Charge Code |
43700501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.63 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna of IA Commercial |
$62.36
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$62.36
|
| Rate for Payer: Aetna of IA Medicare |
$39.50
|
| Rate for Payer: Amerigroup Medicaid |
$34.97
|
| Rate for Payer: Amerigroup Medicare |
$34.99
|
| Rate for Payer: Cash Price |
$55.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$51.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.63
|
| Rate for Payer: Medical Associates Commercial |
$51.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.64
|
| Rate for Payer: Midlands Choice Commercial |
$48.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.97
|
| Rate for Payer: United Healthcare Commercial |
$62.36
|
| Rate for Payer: United Healthcare Managed Medicare |
$40.88
|
|
|
chlorpheniramine 4 mg Tab
|
Facility
OP
|
$1.03
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna of IA Commercial |
$0.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.93
|
| Rate for Payer: Aetna of IA Medicare |
$0.59
|
| Rate for Payer: Amerigroup Medicaid |
$0.52
|
| Rate for Payer: Amerigroup Medicare |
$0.52
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.77
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.51
|
| Rate for Payer: Medical Associates Commercial |
$0.77
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.52
|
| Rate for Payer: Midlands Choice Commercial |
$0.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$0.93
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.61
|
|
|
chlorpheniramine 4 mg Tab
|
Facility
IP
|
$1.03
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna of IA Commercial |
$0.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.93
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.77
|
| Rate for Payer: Medical Associates Commercial |
$0.77
|
| Rate for Payer: Midlands Choice Commercial |
$0.72
|
| Rate for Payer: United Healthcare Commercial |
$0.93
|
|
|
chlorproMAZINE 25 mg/mL 1ml SDV Inj Amp
|
Facility
OP
|
$87.01
|
|
|
Service Code
|
CPT J3230
|
| Hospital Charge Code |
43702072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.49 |
| Max. Negotiated Rate |
$78.31 |
| Rate for Payer: Aetna of IA Commercial |
$78.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$78.31
|
| Rate for Payer: Aetna of IA Medicare |
$49.60
|
| Rate for Payer: Amerigroup Medicaid |
$43.91
|
| Rate for Payer: Amerigroup Medicare |
$43.94
|
| Rate for Payer: Cash Price |
$69.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$65.26
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$43.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.49
|
| Rate for Payer: Medical Associates Commercial |
$65.26
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$60.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$65.26
|
| Rate for Payer: United Healthcare Commercial |
$78.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.34
|
|
|
chlorproMAZINE 25 mg/mL 1ml SDV Inj Amp
|
Facility
IP
|
$87.01
|
|
|
Service Code
|
CPT J3230
|
| Hospital Charge Code |
43702072
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.91 |
| Max. Negotiated Rate |
$78.31 |
| Rate for Payer: Aetna of IA Commercial |
$78.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$78.31
|
| Rate for Payer: Cash Price |
$69.61
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$65.26
|
| Rate for Payer: Medical Associates Commercial |
$65.26
|
| Rate for Payer: Midlands Choice Commercial |
$60.91
|
| Rate for Payer: United Healthcare Commercial |
$78.31
|
|
|
chlorthalidone 25 mg Tab
|
Facility
IP
|
$1.35
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of IA Commercial |
$1.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.22
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.01
|
| Rate for Payer: Medical Associates Commercial |
$1.01
|
| Rate for Payer: Midlands Choice Commercial |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.22
|
|
|
chlorthalidone 25 mg Tab
|
Facility
OP
|
$1.35
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701908
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna of IA Commercial |
$1.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.22
|
| Rate for Payer: Aetna of IA Medicare |
$0.77
|
| Rate for Payer: Amerigroup Medicaid |
$0.68
|
| Rate for Payer: Amerigroup Medicare |
$0.68
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.01
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.67
|
| Rate for Payer: Medical Associates Commercial |
$1.01
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.68
|
| Rate for Payer: Midlands Choice Commercial |
$0.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.80
|
|
|
cholecalciferol 125 mcg (5000 intl units) Cap
|
Facility
OP
|
$1.07
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of IA Commercial |
$0.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.96
|
| Rate for Payer: Aetna of IA Medicare |
$0.61
|
| Rate for Payer: Amerigroup Medicaid |
$0.54
|
| Rate for Payer: Amerigroup Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.53
|
| Rate for Payer: Medical Associates Commercial |
$0.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.54
|
| Rate for Payer: Midlands Choice Commercial |
$0.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.80
|
| Rate for Payer: United Healthcare Commercial |
$0.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.63
|
|
|
cholecalciferol 125 mcg (5000 intl units) Cap
|
Facility
IP
|
$1.07
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of IA Commercial |
$0.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.96
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.80
|
| Rate for Payer: Medical Associates Commercial |
$0.80
|
| Rate for Payer: Midlands Choice Commercial |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$0.96
|
|
|
cholecalciferol 25mcg (1000 intl units) tablet
|
Facility
OP
|
$1.07
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43766109
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of IA Commercial |
$0.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.96
|
| Rate for Payer: Aetna of IA Medicare |
$0.61
|
| Rate for Payer: Amerigroup Medicaid |
$0.54
|
| Rate for Payer: Amerigroup Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.53
|
| Rate for Payer: Medical Associates Commercial |
$0.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.54
|
| Rate for Payer: Midlands Choice Commercial |
$0.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.80
|
| Rate for Payer: United Healthcare Commercial |
$0.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.63
|
|
|
cholecalciferol 25mcg (1000 intl units) tablet
|
Facility
IP
|
$1.07
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43766109
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of IA Commercial |
$0.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.96
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.80
|
| Rate for Payer: Medical Associates Commercial |
$0.80
|
| Rate for Payer: Midlands Choice Commercial |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$0.96
|
|
|
cholecalciferol 50 mcg (2000 intl units) Cap
|
Facility
OP
|
$1.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43768945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of IA Commercial |
$1.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.04
|
| Rate for Payer: Aetna of IA Medicare |
$0.66
|
| Rate for Payer: Amerigroup Medicaid |
$0.59
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.87
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.58
|
| Rate for Payer: Medical Associates Commercial |
$0.87
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.58
|
| Rate for Payer: Midlands Choice Commercial |
$0.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.59
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.68
|
|
|
cholecalciferol 50 mcg (2000 intl units) Cap
|
Facility
IP
|
$1.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43768945
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of IA Commercial |
$1.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.04
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.87
|
| Rate for Payer: Medical Associates Commercial |
$0.87
|
| Rate for Payer: Midlands Choice Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
|
|
Cholecystectomy;
|
Facility
OP
|
$12,406.26
|
|
|
Service Code
|
CPT 47600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,278.42 |
| Max. Negotiated Rate |
$12,406.26 |
| Rate for Payer: Wellmark IA HMO |
$11,278.42
|
| Rate for Payer: Wellmark IA PPO |
$12,406.26
|
|
|
Cholecystectomy Except by Laparoscope Without C.D.E. With CC
|
Facility
IP
|
$17,732.10
|
|
|
Service Code
|
MS-DRG 415
|
| Hospital Charge Code |
247
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$17,732.10 |
| Rate for Payer: Amerigroup Medicaid |
$17,646.43
|
| 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 |
$17,475.11
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17,732.10
|
|
|
Cholecystectomy Except by Laparoscope Without C.D.E. With MCC
|
Facility
IP
|
$21,878.71
|
|
|
Service Code
|
MS-DRG 414
|
| Hospital Charge Code |
246
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$21,878.71 |
| Rate for Payer: Amerigroup Medicaid |
$21,773.02
|
| 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 |
$21,561.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21,878.71
|
|
|
Cholecystectomy Except by Laparoscope Without C.D.E. Without CC/MCC
|
Facility
IP
|
$16,984.07
|
|
|
Service Code
|
MS-DRG 416
|
| Hospital Charge Code |
248
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$16,984.07 |
| Rate for Payer: Amerigroup Medicaid |
$16,902.02
|
| 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 |
$16,737.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,984.07
|
|
|
Cholecystectomy With C.D.E. With CC
|
Facility
IP
|
$22,404.29
|
|
|
Service Code
|
MS-DRG 412
|
| Hospital Charge Code |
244
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$22,404.29 |
| Rate for Payer: Amerigroup Medicaid |
$22,296.06
|
| 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 |
$22,079.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22,404.29
|
|
|
Cholecystectomy With C.D.E. With MCC
|
Facility
IP
|
$36,942.52
|
|
|
Service Code
|
MS-DRG 411
|
| Hospital Charge Code |
243
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$36,942.52 |
| Rate for Payer: Amerigroup Medicaid |
$36,764.06
|
| 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 |
$36,407.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36,942.52
|
|
