|
Lactated Ringers IV Sol 500 mL [VDMC]
|
Facility
|
OP
|
$74.52
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
10431177
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$67.07 |
| Rate for Payer: Aetna of IA Commercial |
$67.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.07
|
| Rate for Payer: Aetna of IA Medicare |
$42.48
|
| Rate for Payer: Amerigroup Medicaid |
$37.61
|
| Rate for Payer: Amerigroup Medicare |
$37.63
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$37.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.25
|
| Rate for Payer: Medical Associates Commercial |
$55.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.26
|
| Rate for Payer: Midlands Choice Commercial |
$52.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.82
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$37.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$55.89
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.89
|
| Rate for Payer: United Healthcare Commercial |
$67.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.97
|
|
|
LACTIC ACID
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
1503766
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
LACTIC ACID
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
1503766
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
lactobacillus acidophilus and bulgaricus Chew Tab [VDMC]
|
Facility
|
IP
|
$1.66
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10398885
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of IA Commercial |
$1.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.49
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.24
|
| Rate for Payer: Medical Associates Commercial |
$1.24
|
| Rate for Payer: Midlands Choice Commercial |
$1.16
|
| Rate for Payer: United Healthcare Commercial |
$1.49
|
|
|
lactobacillus acidophilus and bulgaricus Chew Tab [VDMC]
|
Facility
|
OP
|
$1.66
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10398885
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.49 |
| Rate for Payer: Aetna of IA Commercial |
$1.49
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.49
|
| Rate for Payer: Aetna of IA Medicare |
$0.95
|
| Rate for Payer: Amerigroup Medicaid |
$0.84
|
| Rate for Payer: Amerigroup Medicare |
$0.84
|
| Rate for Payer: Cash Price |
$1.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.24
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.83
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$1.24
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.83
|
| Rate for Payer: Midlands Choice Commercial |
$1.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.84
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.24
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.24
|
| Rate for Payer: United Healthcare Commercial |
$1.49
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.98
|
|
|
lactulose 20 g/30 mL Syr UD [VDMC]
|
Facility
|
OP
|
$7.93
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222102
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Aetna of IA Commercial |
$7.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.14
|
| Rate for Payer: Aetna of IA Medicare |
$4.52
|
| Rate for Payer: Amerigroup Medicaid |
$4.00
|
| Rate for Payer: Amerigroup Medicare |
$4.00
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.96
|
| Rate for Payer: Medical Associates Commercial |
$5.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.96
|
| Rate for Payer: Midlands Choice Commercial |
$5.55
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.02
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$4.02
|
| Rate for Payer: Oscar Health of IA Commercial |
$5.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.95
|
| Rate for Payer: United Healthcare Commercial |
$7.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.68
|
|
|
lactulose 20 g/30 mL Syr UD [VDMC]
|
Facility
|
IP
|
$7.93
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222102
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$7.14 |
| Rate for Payer: Aetna of IA Commercial |
$7.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.14
|
| Rate for Payer: Cash Price |
$6.35
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.95
|
| Rate for Payer: Medical Associates Commercial |
$5.95
|
| Rate for Payer: Midlands Choice Commercial |
$5.55
|
| Rate for Payer: United Healthcare Commercial |
$7.14
|
|
|
LAMINECT IMPL NS ELECTRODES EPIDURAL
|
Professional
|
Both
|
$2,810.00
|
|
|
Service Code
|
CPT 63655
|
| Hospital Charge Code |
8015897
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$739.39 |
| Max. Negotiated Rate |
$1,967.00 |
| Rate for Payer: Aetna of IA Medicare |
$739.39
|
| Rate for Payer: Amerigroup Medicaid |
$764.53
|
| Rate for Payer: Cash Price |
$2,248.00
|
| Rate for Payer: Cash Price |
$2,248.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$887.27
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$754.18
|
| Rate for Payer: Medical Associates Commercial |
$1,404.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$739.39
|
| Rate for Payer: Midlands Choice Commercial |
$1,967.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,279.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,109.08
|
|
|
lamoTRIgine 100 mg Tab [VDMC]
|
Facility
|
OP
|
$1.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10398954
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| 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 |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.56
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.57
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.57
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.67
|
|
|
lamoTRIgine 100 mg Tab [VDMC]
|
Facility
|
IP
|
$1.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10398954
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
|
|
lamoTRIgine 25 mg Tab [VDMC]
|
Facility
|
OP
|
$1.22
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10399025
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of IA Commercial |
$1.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.10
|
| Rate for Payer: Aetna of IA Medicare |
$0.70
|
| Rate for Payer: Amerigroup Medicaid |
$0.62
|
| Rate for Payer: Amerigroup Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.92
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.61
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.61
|
| Rate for Payer: Medical Associates Commercial |
$0.92
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.61
|
| Rate for Payer: Midlands Choice Commercial |
$0.85
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.62
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.72
|
|
|
lamoTRIgine 25 mg Tab [VDMC]
|
Facility
|
IP
|
$1.22
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10399025
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna of IA Commercial |
$1.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.10
|
| Rate for Payer: Cash Price |
$0.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.92
|
| Rate for Payer: Medical Associates Commercial |
$0.92
|
| Rate for Payer: Midlands Choice Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.10
|
|
|
Lamotrigine Level DMCL
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
8037722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
|
|
Lamotrigine Level DMCL
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
8037722
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Aetna of IA Medicare |
$68.97
|
| Rate for Payer: Amerigroup Medicaid |
$61.07
|
| Rate for Payer: Amerigroup Medicare |
$61.10
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$60.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$60.48
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$60.50
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$61.41
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$61.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$90.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$90.75
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.39
|
| Rate for Payer: Wellmark IA HMO |
$49.60
|
| Rate for Payer: Wellmark IA PPO |
$54.56
|
|
|
lansoprazole 30 mg Oral EC Cap [VDMC]
|
Facility
|
OP
|
$1.33
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10399094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of IA Commercial |
$1.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.20
|
| Rate for Payer: Aetna of IA Medicare |
$0.76
|
| Rate for Payer: Amerigroup Medicaid |
$0.67
|
| Rate for Payer: Amerigroup Medicare |
$0.67
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.66
|
| Rate for Payer: Medical Associates Commercial |
$1.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.67
|
| Rate for Payer: Midlands Choice Commercial |
$0.93
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.67
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$1.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.78
|
|
|
lansoprazole 30 mg Oral EC Cap [VDMC]
|
Facility
|
IP
|
$1.33
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10399094
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna of IA Commercial |
$1.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.20
|
| Rate for Payer: Cash Price |
$1.07
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.00
|
| Rate for Payer: Medical Associates Commercial |
$1.00
|
| Rate for Payer: Midlands Choice Commercial |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$1.20
|
|
|
lansoprazole 3 mg/mL 300ml Suspenion [VDMC]
|
Facility
|
IP
|
$394.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23101429
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$275.97 |
| Max. Negotiated Rate |
$354.82 |
| Rate for Payer: Aetna of IA Commercial |
$354.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$354.82
|
| Rate for Payer: Cash Price |
$315.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$295.68
|
| Rate for Payer: Medical Associates Commercial |
$295.68
|
| Rate for Payer: Midlands Choice Commercial |
$275.97
|
| Rate for Payer: United Healthcare Commercial |
$354.82
|
|
|
lansoprazole 3 mg/mL 300ml Suspenion [VDMC]
|
Facility
|
OP
|
$394.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23101429
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$197.04 |
| Max. Negotiated Rate |
$354.82 |
| Rate for Payer: Aetna of IA Commercial |
$354.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$354.82
|
| Rate for Payer: Aetna of IA Medicare |
$224.72
|
| Rate for Payer: Amerigroup Medicaid |
$198.97
|
| Rate for Payer: Amerigroup Medicare |
$199.09
|
| Rate for Payer: Cash Price |
$315.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$295.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$197.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$197.04
|
| Rate for Payer: Medical Associates Commercial |
$295.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$197.12
|
| Rate for Payer: Midlands Choice Commercial |
$275.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$200.08
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$199.96
|
| Rate for Payer: Oscar Health of IA Commercial |
$295.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$295.68
|
| Rate for Payer: United Healthcare Commercial |
$354.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$232.60
|
|
|
LAP; ABD PERIT OMENTUM W ASP CYST
|
Professional
|
Both
|
$1,245.00
|
|
|
Service Code
|
CPT 49322
|
| Hospital Charge Code |
8069087
|
|
Hospital Revenue Code
|
983
|
| Min. Negotiated Rate |
$334.19 |
| Max. Negotiated Rate |
$871.50 |
| Rate for Payer: Aetna of IA Medicare |
$334.19
|
| Rate for Payer: Amerigroup Medicaid |
$345.55
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Cash Price |
$996.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$401.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$340.87
|
| Rate for Payer: Medical Associates Commercial |
$601.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$334.19
|
| Rate for Payer: Midlands Choice Commercial |
$871.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$578.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$501.28
|
|
|
Laparoscopic Cholecystectomy Without C.D.E. With CC
|
Facility
|
IP
|
$13,936.86
|
|
|
Service Code
|
MS-DRG 418
|
| Hospital Charge Code |
250
|
| Min. Negotiated Rate |
$13,734.88 |
| Max. Negotiated Rate |
$13,936.86 |
| Rate for Payer: Amerigroup Medicaid |
$13,869.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,734.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,936.86
|
|
|
Laparoscopic Cholecystectomy Without C.D.E. With MCC
|
Facility
|
IP
|
$16,302.00
|
|
|
Service Code
|
MS-DRG 417
|
| Hospital Charge Code |
249
|
| Min. Negotiated Rate |
$16,065.73 |
| Max. Negotiated Rate |
$16,302.00 |
| Rate for Payer: Amerigroup Medicaid |
$16,223.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16,065.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16,302.00
|
|
|
Laparoscopic Cholecystectomy Without C.D.E. Without CC/MCC
|
Facility
|
IP
|
$11,078.62
|
|
|
Service Code
|
MS-DRG 419
|
| Hospital Charge Code |
251
|
| Min. Negotiated Rate |
$10,918.06 |
| Max. Negotiated Rate |
$11,078.62 |
| Rate for Payer: Amerigroup Medicaid |
$11,025.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,918.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11,078.62
|
|
|
Laparoscopic colectomy partial with anastomosis
|
Professional
|
Both
|
$5,204.00
|
|
|
Service Code
|
CPT 44204
|
| Hospital Charge Code |
8068987
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$1,358.92 |
| Max. Negotiated Rate |
$3,642.80 |
| Rate for Payer: Aetna of IA Medicare |
$1,358.92
|
| Rate for Payer: Amerigroup Medicaid |
$1,405.12
|
| Rate for Payer: Cash Price |
$4,163.20
|
| Rate for Payer: Cash Price |
$4,163.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,630.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,386.10
|
| Rate for Payer: Medical Associates Commercial |
$2,581.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,358.92
|
| Rate for Payer: Midlands Choice Commercial |
$3,642.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,350.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,038.38
|
|
|
Laparoscopic urethral sling for stress incontinence
|
Professional
|
Both
|
$2,826.00
|
|
|
Service Code
|
CPT 51992
|
| Hospital Charge Code |
8069155
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$756.60 |
| Max. Negotiated Rate |
$1,978.20 |
| Rate for Payer: Aetna of IA Medicare |
$756.60
|
| Rate for Payer: Amerigroup Medicaid |
$782.32
|
| Rate for Payer: Cash Price |
$2,260.80
|
| Rate for Payer: Cash Price |
$2,260.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$907.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$771.73
|
| Rate for Payer: Medical Associates Commercial |
$1,437.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$756.60
|
| Rate for Payer: Midlands Choice Commercial |
$1,978.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,308.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,134.90
|
|
|
Laparoscopy, surgical, appendectomy
|
Facility
|
OP
|
$9,126.52
|
|
|
Service Code
|
CPT 44970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,296.84 |
| Max. Negotiated Rate |
$9,126.52 |
| Rate for Payer: Wellmark IA HMO |
$8,296.84
|
| Rate for Payer: Wellmark IA PPO |
$9,126.52
|
|
