|
lidocaine Topical 4% Sol 50ml
|
Facility
IP
|
$15.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna of IA Commercial |
$13.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.86
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.55
|
| Rate for Payer: Medical Associates Commercial |
$11.55
|
| Rate for Payer: Midlands Choice Commercial |
$10.78
|
| Rate for Payer: United Healthcare Commercial |
$13.86
|
|
|
lidocaine Topical 4% Sol 50ml
|
Facility
OP
|
$15.40
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$13.86 |
| Rate for Payer: Aetna of IA Commercial |
$13.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.86
|
| Rate for Payer: Aetna of IA Medicare |
$8.78
|
| Rate for Payer: Amerigroup Medicaid |
$7.77
|
| Rate for Payer: Amerigroup Medicare |
$7.78
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.70
|
| Rate for Payer: Medical Associates Commercial |
$11.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.70
|
| Rate for Payer: Midlands Choice Commercial |
$10.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.55
|
| Rate for Payer: United Healthcare Commercial |
$13.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.09
|
|
|
lidocaine Top Patch 5% film
|
Facility
IP
|
$14.21
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43751277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$12.79 |
| Rate for Payer: Aetna of IA Commercial |
$12.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.79
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.66
|
| Rate for Payer: Medical Associates Commercial |
$10.66
|
| Rate for Payer: Midlands Choice Commercial |
$9.95
|
| Rate for Payer: United Healthcare Commercial |
$12.79
|
|
|
lidocaine Top Patch 5% film
|
Facility
OP
|
$14.21
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43751277
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$12.79 |
| Rate for Payer: Aetna of IA Commercial |
$12.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.79
|
| Rate for Payer: Aetna of IA Medicare |
$8.10
|
| Rate for Payer: Amerigroup Medicaid |
$7.17
|
| Rate for Payer: Amerigroup Medicare |
$7.18
|
| Rate for Payer: Cash Price |
$11.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.10
|
| Rate for Payer: Medical Associates Commercial |
$10.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.10
|
| Rate for Payer: Midlands Choice Commercial |
$9.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.66
|
| Rate for Payer: United Healthcare Commercial |
$12.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.38
|
|
|
LIGATION OF HEMORRHOID(S)
|
Facility
IP
|
$815.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
4864973
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$570.50 |
| Max. Negotiated Rate |
$733.50 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
|
|
LIGATION OF HEMORRHOID(S)
|
Facility
OP
|
$815.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
4864973
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$407.34 |
| Max. Negotiated Rate |
$1,451.30 |
| Rate for Payer: Aetna of IA Commercial |
$733.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$733.50
|
| Rate for Payer: Aetna of IA Medicare |
$464.55
|
| Rate for Payer: Amerigroup Medicaid |
$411.33
|
| Rate for Payer: Amerigroup Medicare |
$411.58
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Cash Price |
$652.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$611.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$407.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$407.34
|
| Rate for Payer: Medical Associates Commercial |
$611.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$407.50
|
| Rate for Payer: Midlands Choice Commercial |
$570.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$413.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$611.25
|
| Rate for Payer: United Healthcare Commercial |
$733.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$480.85
|
| Rate for Payer: Wellmark IA HMO |
$1,319.36
|
| Rate for Payer: Wellmark IA PPO |
$1,451.30
|
|
|
Light Chains Quantitative DMCL
|
Facility
OP
|
$130.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
8037726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Aetna of IA Medicare |
$74.10
|
| Rate for Payer: Amerigroup Medicaid |
$65.61
|
| Rate for Payer: Amerigroup Medicare |
$65.65
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$65.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.97
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.00
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.98
|
| Rate for Payer: Partners Health Alliance Commercial |
$97.50
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.70
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Light Chains Quantitative DMCL
|
Facility
IP
|
$130.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
8037726
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna of IA Commercial |
$117.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$117.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$97.50
|
| Rate for Payer: Medical Associates Commercial |
$97.50
|
| Rate for Payer: Midlands Choice Commercial |
$91.00
|
| Rate for Payer: United Healthcare Commercial |
$117.00
|
|
|
Limb Reattachment, Hip and Femur Procedures for Multiple Significant Trauma
|
Facility
IP
|
$47,847.92
|
|
|
Service Code
|
MS-DRG 956
|
| Hospital Charge Code |
659
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$47,847.92 |
| Rate for Payer: Amerigroup Medicaid |
$47,616.77
|
| 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 |
$47,154.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47,847.92
|
|
|
linaclotide 145 mcg Cap
|
Facility
OP
|
$64.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.07 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna of IA Commercial |
$57.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.74
|
| Rate for Payer: Aetna of IA Medicare |
$36.57
|
| Rate for Payer: Amerigroup Medicaid |
$32.38
|
| Rate for Payer: Amerigroup Medicare |
$32.40
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.07
|
| Rate for Payer: Medical Associates Commercial |
$48.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.08
|
| Rate for Payer: Midlands Choice Commercial |
$44.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.12
|
| Rate for Payer: United Healthcare Commercial |
$57.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.85
|
|
|
linaclotide 145 mcg Cap
|
Facility
IP
|
$64.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700348
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.91 |
| Max. Negotiated Rate |
$57.74 |
| Rate for Payer: Aetna of IA Commercial |
$57.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.74
|
| Rate for Payer: Cash Price |
$51.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.12
|
| Rate for Payer: Medical Associates Commercial |
$48.12
|
| Rate for Payer: Midlands Choice Commercial |
$44.91
|
| Rate for Payer: United Healthcare Commercial |
$57.74
|
|
|
linagliptin 5 mg Tab
|
Facility
IP
|
$62.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$56.34 |
| Rate for Payer: Aetna of IA Commercial |
$56.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.34
|
| Rate for Payer: Cash Price |
$50.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.95
|
| Rate for Payer: Medical Associates Commercial |
$46.95
|
| Rate for Payer: Midlands Choice Commercial |
$43.82
|
| Rate for Payer: United Healthcare Commercial |
$56.34
|
|
|
linagliptin 5 mg Tab
|
Facility
OP
|
$62.60
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700197
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$56.34 |
| Rate for Payer: Aetna of IA Commercial |
$56.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$56.34
|
| Rate for Payer: Aetna of IA Medicare |
$35.68
|
| Rate for Payer: Amerigroup Medicaid |
$31.59
|
| Rate for Payer: Amerigroup Medicare |
$31.61
|
| Rate for Payer: Cash Price |
$50.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$31.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.29
|
| Rate for Payer: Medical Associates Commercial |
$46.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$31.30
|
| Rate for Payer: Midlands Choice Commercial |
$43.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$46.95
|
| Rate for Payer: United Healthcare Commercial |
$56.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.93
|
|
|
linezolid 2 mg/mL-D5% 300ml
|
Facility
IP
|
$84.92
|
|
|
Service Code
|
CPT J2020
|
| Hospital Charge Code |
43745187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$76.43 |
| Rate for Payer: Aetna of IA Commercial |
$76.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.43
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.69
|
| Rate for Payer: Medical Associates Commercial |
$63.69
|
| Rate for Payer: Midlands Choice Commercial |
$59.44
|
| Rate for Payer: United Healthcare Commercial |
$76.43
|
|
|
linezolid 2 mg/mL-D5% 300ml
|
Facility
OP
|
$84.92
|
|
|
Service Code
|
CPT J2020
|
| Hospital Charge Code |
43745187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.44 |
| Max. Negotiated Rate |
$76.43 |
| Rate for Payer: Aetna of IA Commercial |
$76.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$76.43
|
| Rate for Payer: Aetna of IA Medicare |
$48.40
|
| Rate for Payer: Amerigroup Medicaid |
$42.86
|
| Rate for Payer: Amerigroup Medicare |
$42.88
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$63.69
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$42.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.44
|
| Rate for Payer: Medical Associates Commercial |
$63.69
|
| Rate for Payer: Medical Associates Managed Medicare |
$42.46
|
| Rate for Payer: Midlands Choice Commercial |
$59.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.69
|
| Rate for Payer: United Healthcare Commercial |
$76.43
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.10
|
|
|
linezolid 600 mg Tab
|
Facility
OP
|
$7.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43743809
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Aetna of IA Commercial |
$7.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.16
|
| Rate for Payer: Aetna of IA Medicare |
$4.54
|
| Rate for Payer: Amerigroup Medicaid |
$4.02
|
| Rate for Payer: Amerigroup Medicare |
$4.02
|
| Rate for Payer: Cash Price |
$6.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.98
|
| Rate for Payer: Medical Associates Commercial |
$5.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.98
|
| Rate for Payer: Midlands Choice Commercial |
$5.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.97
|
| Rate for Payer: United Healthcare Commercial |
$7.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.70
|
|
|
linezolid 600 mg Tab
|
Facility
IP
|
$7.96
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43743809
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Aetna of IA Commercial |
$7.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.16
|
| Rate for Payer: Cash Price |
$6.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.97
|
| Rate for Payer: Medical Associates Commercial |
$5.97
|
| Rate for Payer: Midlands Choice Commercial |
$5.57
|
| Rate for Payer: United Healthcare Commercial |
$7.16
|
|
|
liothyronine 5 mcg Tab
|
Facility
IP
|
$2.63
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700591
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Aetna of IA Commercial |
$2.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.37
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.97
|
| Rate for Payer: Medical Associates Commercial |
$1.97
|
| Rate for Payer: Midlands Choice Commercial |
$1.84
|
| Rate for Payer: United Healthcare Commercial |
$2.37
|
|
|
liothyronine 5 mcg Tab
|
Facility
OP
|
$2.63
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700591
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$2.37 |
| Rate for Payer: Aetna of IA Commercial |
$2.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.37
|
| Rate for Payer: Aetna of IA Medicare |
$1.50
|
| Rate for Payer: Amerigroup Medicaid |
$1.33
|
| Rate for Payer: Amerigroup Medicare |
$1.33
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.31
|
| Rate for Payer: Medical Associates Commercial |
$1.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.32
|
| Rate for Payer: Midlands Choice Commercial |
$1.84
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.33
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.97
|
| Rate for Payer: United Healthcare Commercial |
$2.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.55
|
|
|
LIPASE
|
Facility
IP
|
$72.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of IA Commercial |
$64.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.00
|
| Rate for Payer: Medical Associates Commercial |
$54.00
|
| Rate for Payer: Midlands Choice Commercial |
$50.40
|
| Rate for Payer: United Healthcare Commercial |
$64.80
|
|
|
LIPASE
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna of IA Commercial |
$64.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$64.80
|
| Rate for Payer: Aetna of IA Medicare |
$41.04
|
| Rate for Payer: Amerigroup Medicaid |
$36.34
|
| Rate for Payer: Amerigroup Medicare |
$36.36
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.99
|
| Rate for Payer: Medical Associates Commercial |
$54.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.00
|
| Rate for Payer: Midlands Choice Commercial |
$50.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.54
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$64.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.48
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
LIPECTOMY CHARGE
|
Professional
|
$3,054.00
|
|
|
Service Code
|
CPT 15832
|
| Hospital Charge Code |
8068936
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$829.17 |
| Max. Negotiated Rate |
$2,137.80 |
| Rate for Payer: Aetna of IA Medicare |
$829.17
|
| Rate for Payer: Amerigroup Medicaid |
$857.36
|
| Rate for Payer: Cash Price |
$2,443.20
|
| Rate for Payer: Cash Price |
$2,443.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$995.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$845.75
|
| Rate for Payer: Medical Associates Commercial |
$1,575.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$829.17
|
| Rate for Payer: Midlands Choice Commercial |
$2,137.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,243.76
|
| Rate for Payer: Wellmark IA HMO |
$1,651.00
|
| Rate for Payer: Wellmark IA PPO |
$1,938.00
|
|
|
LIPID PROFILE
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
633777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
|
|
LIPID PROFILE
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
633777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Aetna of IA Commercial |
$98.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$98.10
|
| Rate for Payer: Aetna of IA Medicare |
$62.13
|
| Rate for Payer: Amerigroup Medicaid |
$55.01
|
| Rate for Payer: Amerigroup Medicare |
$55.04
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$54.48
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.50
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$81.75
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
| Rate for Payer: Wellmark IA HMO |
$52.08
|
| Rate for Payer: Wellmark IA PPO |
$57.29
|
|
|
Lipoprotein A DMCL
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
8632496
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna of IA Commercial |
$126.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$126.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
|
