|
losartan-hydrochlorothiazide 50 mg- 12.5 mg-Tab
|
Facility
IP
|
$1.77
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705883
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna of IA Commercial |
$1.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.59
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.33
|
| Rate for Payer: Medical Associates Commercial |
$1.33
|
| Rate for Payer: Midlands Choice Commercial |
$1.24
|
| Rate for Payer: United Healthcare Commercial |
$1.59
|
|
|
Lower Extremity and Humerus Procedures Except Hip, Foot and Femur With CC
|
Facility
IP
|
$21,225.17
|
|
|
Service Code
|
MS-DRG 493
|
| Hospital Charge Code |
310
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$21,225.17 |
| Rate for Payer: Amerigroup Medicaid |
$21,122.63
|
| 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 |
$20,917.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$21,225.17
|
|
|
Lower Extremity and Humerus Procedures Except Hip, Foot and Femur With MCC
|
Facility
IP
|
$35,623.63
|
|
|
Service Code
|
MS-DRG 492
|
| Hospital Charge Code |
309
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$35,623.63 |
| Rate for Payer: Amerigroup Medicaid |
$35,451.54
|
| 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 |
$35,107.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35,623.63
|
|
|
Lower Extremity and Humerus Procedures Except Hip, Foot and Femur Without CC/MCC
|
Facility
IP
|
$14,642.56
|
|
|
Service Code
|
MS-DRG 494
|
| Hospital Charge Code |
311
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,642.56 |
| Rate for Payer: Amerigroup Medicaid |
$14,571.82
|
| 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 |
$14,430.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,642.56
|
|
|
lubiprostone 24 mcg oral capsule
|
Facility
OP
|
$4.68
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43766827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.34 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna of IA Commercial |
$4.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.21
|
| Rate for Payer: Aetna of IA Medicare |
$2.67
|
| Rate for Payer: Amerigroup Medicaid |
$2.36
|
| Rate for Payer: Amerigroup Medicare |
$2.36
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.51
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.34
|
| Rate for Payer: Medical Associates Commercial |
$3.51
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.34
|
| Rate for Payer: Midlands Choice Commercial |
$3.28
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.51
|
| Rate for Payer: United Healthcare Commercial |
$4.21
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.76
|
|
|
lubiprostone 24 mcg oral capsule
|
Facility
IP
|
$4.68
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43766827
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$4.21 |
| Rate for Payer: Aetna of IA Commercial |
$4.21
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$4.21
|
| Rate for Payer: Cash Price |
$3.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.51
|
| Rate for Payer: Medical Associates Commercial |
$3.51
|
| Rate for Payer: Midlands Choice Commercial |
$3.28
|
| Rate for Payer: United Healthcare Commercial |
$4.21
|
|
|
Lung Transplant
|
Facility
IP
|
$151,601.74
|
|
|
Service Code
|
MS-DRG 007
|
| Hospital Charge Code |
698
|
| Min. Negotiated Rate |
$149,404.61 |
| Max. Negotiated Rate |
$151,601.74 |
| Rate for Payer: Amerigroup Medicaid |
$150,869.36
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$149,404.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$151,601.74
|
|
|
Lupus Anticoagulant DMCL
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
8037728
|
|
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
|
|
|
Lupus Anticoagulant DMCL
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
8037728
|
|
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
|
|
|
Luteinizing Hormone DMCL
|
Facility
IP
|
$135.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
8037729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
|
|
Luteinizing Hormone DMCL
|
Facility
OP
|
$135.00
|
|
|
Service Code
|
CPT 83002
|
| Hospital Charge Code |
8037729
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Aetna of IA Commercial |
$121.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$121.50
|
| Rate for Payer: Aetna of IA Medicare |
$76.95
|
| Rate for Payer: Amerigroup Medicaid |
$68.13
|
| Rate for Payer: Amerigroup Medicare |
$68.18
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$101.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$67.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$67.47
|
| Rate for Payer: Medical Associates Commercial |
$101.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$67.50
|
| Rate for Payer: Midlands Choice Commercial |
$94.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$68.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$101.25
|
| Rate for Payer: United Healthcare Commercial |
$121.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$79.65
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Lyme Antibody Screen DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
8037730
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
Lyme Antibody Screen DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
8037730
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| 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: 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 |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Lyme by PCR DMCL
|
Facility
IP
|
$290.00
|
|
|
Service Code
|
CPT 87476
|
| Hospital Charge Code |
8037731
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$203.00 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of IA Commercial |
$261.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$261.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$217.50
|
| Rate for Payer: Medical Associates Commercial |
$217.50
|
| Rate for Payer: Midlands Choice Commercial |
$203.00
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
|
|
Lyme by PCR DMCL
|
Facility
OP
|
$290.00
|
|
|
Service Code
|
CPT 87476
|
| Hospital Charge Code |
8037731
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.82 |
| Max. Negotiated Rate |
$261.00 |
| Rate for Payer: Aetna of IA Commercial |
$261.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$261.00
|
| Rate for Payer: Aetna of IA Medicare |
$165.30
|
| Rate for Payer: Amerigroup Medicaid |
$146.36
|
| Rate for Payer: Amerigroup Medicare |
$146.45
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$217.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$145.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$144.94
|
| Rate for Payer: Medical Associates Commercial |
$217.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$145.00
|
| Rate for Payer: Midlands Choice Commercial |
$203.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$147.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$217.50
|
| Rate for Payer: United Healthcare Commercial |
$261.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$171.10
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
Lyme IgG Antibody DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
8505651
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
Lyme IgG Antibody DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
8505651
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| 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: 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 |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Lyme IgM Antibody DMCL
|
Facility
OP
|
$139.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
8505652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| 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: 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 |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
Lyme IgM Antibody DMCL
|
Facility
IP
|
$139.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
8505652
|
|
Hospital Revenue Code
|
302
|
| 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
|
|
|
Lymphoma and Leukemia With Major O.R. Procedures With CC
|
Facility
IP
|
$18,352.16
|
|
|
Service Code
|
MS-DRG 821
|
| Hospital Charge Code |
563
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$18,352.16 |
| Rate for Payer: Amerigroup Medicaid |
$18,263.51
|
| 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 |
$18,086.19
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18,352.16
|
|
|
Lymphoma and Leukemia With Major O.R. Procedures With MCC
|
Facility
IP
|
$55,991.53
|
|
|
Service Code
|
MS-DRG 820
|
| Hospital Charge Code |
562
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$55,991.53 |
| Rate for Payer: Amerigroup Medicaid |
$55,721.04
|
| 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 |
$55,180.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$55,991.53
|
|
|
Lymphoma and Leukemia With Major O.R. Procedures Without CC/MCC
|
Facility
IP
|
$9,848.33
|
|
|
Service Code
|
MS-DRG 822
|
| Hospital Charge Code |
564
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,848.33 |
| Rate for Payer: Amerigroup Medicaid |
$9,800.75
|
| 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 |
$9,705.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,848.33
|
|
|
Lymphoma and Non-acute Leukemia With CC
|
Facility
IP
|
$14,361.07
|
|
|
Service Code
|
MS-DRG 841
|
| Hospital Charge Code |
583
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$14,361.07 |
| Rate for Payer: Amerigroup Medicaid |
$14,291.69
|
| 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 |
$14,152.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14,361.07
|
|
|
Lymphoma and Non-acute Leukemia With MCC
|
Facility
IP
|
$22,183.82
|
|
|
Service Code
|
MS-DRG 840
|
| Hospital Charge Code |
582
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$22,183.82 |
| Rate for Payer: Amerigroup Medicaid |
$22,076.65
|
| 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 |
$21,862.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$22,183.82
|
|
|
Lymphoma and Non-acute Leukemia With Other Procedures With CC
|
Facility
IP
|
$20,045.06
|
|
|
Service Code
|
MS-DRG 824
|
| Hospital Charge Code |
566
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$20,045.06 |
| Rate for Payer: Amerigroup Medicaid |
$19,948.23
|
| 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 |
$19,754.55
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,045.06
|
|
