|
linezolid 2 mg/mL-D5% 300ml [VDMC]
|
Facility
|
IP
|
$84.92
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
16670233
|
|
Hospital Revenue Code
|
259
|
| 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 600 mg Tab [VDMC]
|
Facility
|
IP
|
$7.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400948
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna of IA Commercial |
$7.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.17
|
| 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 |
$7.17
|
|
|
linezolid 600 mg Tab [VDMC]
|
Facility
|
OP
|
$7.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10400948
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$7.17 |
| Rate for Payer: Aetna of IA Commercial |
$7.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.17
|
| Rate for Payer: Aetna of IA Medicare |
$4.54
|
| Rate for Payer: Amerigroup Medicaid |
$4.59
|
| Rate for Payer: Amerigroup Medicare |
$3.62
|
| 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 |
$3.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.55
|
| Rate for Payer: Medical Associates Commercial |
$5.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.58
|
| Rate for Payer: Midlands Choice Commercial |
$5.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.62
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.12
|
| Rate for Payer: United Healthcare Commercial |
$7.17
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.70
|
|
|
liothyronine 5 mcg Tab [VDMC]
|
Facility
|
OP
|
$2.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401017
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna of IA Commercial |
$2.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.34
|
| Rate for Payer: Aetna of IA Medicare |
$1.48
|
| Rate for Payer: Amerigroup Medicaid |
$1.50
|
| Rate for Payer: Amerigroup Medicare |
$1.18
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.17
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.48
|
| Rate for Payer: Medical Associates Commercial |
$1.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.17
|
| Rate for Payer: Midlands Choice Commercial |
$1.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$2.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.53
|
|
|
liothyronine 5 mcg Tab [VDMC]
|
Facility
|
IP
|
$2.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401017
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$2.34 |
| Rate for Payer: Aetna of IA Commercial |
$2.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.34
|
| Rate for Payer: Cash Price |
$2.08
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.95
|
| Rate for Payer: Medical Associates Commercial |
$1.95
|
| Rate for Payer: Midlands Choice Commercial |
$1.82
|
| Rate for Payer: United Healthcare Commercial |
$2.34
|
|
|
LIPASE
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$30.49 |
| 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 |
$41.53
|
| Rate for Payer: Amerigroup Medicare |
$32.72
|
| 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 |
$32.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.13
|
| Rate for Payer: Medical Associates Commercial |
$54.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.40
|
| Rate for Payer: Midlands Choice Commercial |
$50.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.26
|
| Rate for Payer: United Healthcare Commercial |
$64.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$42.48
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
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-protease-amylase 12000-38000-60000 units Cap [VDMC]
|
Facility
|
OP
|
$15.55
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of IA Commercial |
$14.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.00
|
| Rate for Payer: Aetna of IA Medicare |
$8.87
|
| Rate for Payer: Amerigroup Medicaid |
$8.97
|
| Rate for Payer: Amerigroup Medicare |
$7.07
|
| Rate for Payer: Cash Price |
$12.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.67
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.88
|
| Rate for Payer: Medical Associates Commercial |
$11.67
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.00
|
| Rate for Payer: Midlands Choice Commercial |
$10.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$8.05
|
| Rate for Payer: United Healthcare Commercial |
$14.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.18
|
|
|
lipase-protease-amylase 12000-38000-60000 units Cap [VDMC]
|
Facility
|
IP
|
$15.55
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10411455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$14.00 |
| Rate for Payer: Aetna of IA Commercial |
$14.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.00
|
| Rate for Payer: Cash Price |
$12.44
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.67
|
| Rate for Payer: Medical Associates Commercial |
$11.67
|
| Rate for Payer: Midlands Choice Commercial |
$10.89
|
| Rate for Payer: United Healthcare Commercial |
$14.00
|
|
|
LIPECTOMY CHARGE
|
Professional
|
Both
|
$3,054.00
|
|
|
Service Code
|
CPT 15832
|
| Hospital Charge Code |
8068936
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$713.81 |
| Max. Negotiated Rate |
$2,290.50 |
| Rate for Payer: Amerigroup Medicaid |
$720.80
|
| Rate for Payer: Cash Price |
$2,443.20
|
| Rate for Payer: Cash Price |
$2,443.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$713.81
|
| Rate for Payer: Medical Associates Commercial |
$2,290.50
|
| Rate for Payer: Midlands Choice Commercial |
$2,137.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$717.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,290.50
|
| Rate for Payer: United Healthcare Commercial |
$1,394.46
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,685.30
|
| Rate for Payer: Wellmark IA PPO |
$1,982.70
|
|
|
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 |
$49.05 |
| 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 |
$62.87
|
| Rate for Payer: Amerigroup Medicare |
$49.54
|
| 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 |
$49.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.26
|
| Rate for Payer: Medical Associates Commercial |
$81.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.05
|
| Rate for Payer: Midlands Choice Commercial |
$76.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.41
|
| Rate for Payer: United Healthcare Commercial |
$98.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.31
|
| Rate for Payer: Wellmark IA HMO WHPI |
$60.97
|
| Rate for Payer: Wellmark IA PPO |
$67.17
|
|
|
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
|
|
|
Lipoprotein A DMCL
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
8632496
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| 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: Aetna of IA Medicare |
$79.80
|
| Rate for Payer: Amerigroup Medicaid |
$80.75
|
| Rate for Payer: Amerigroup Medicare |
$63.63
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$105.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$63.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$79.97
|
| Rate for Payer: Medical Associates Commercial |
$105.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$63.00
|
| Rate for Payer: Midlands Choice Commercial |
$98.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$81.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$72.45
|
| Rate for Payer: United Healthcare Commercial |
$126.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.60
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
liraglutide 18 mg/3 mL Sol [VDMC]
|
Facility
|
IP
|
$1,019.86
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10401086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$713.90 |
| Max. Negotiated Rate |
$917.87 |
| Rate for Payer: Aetna of IA Commercial |
$917.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$917.87
|
| Rate for Payer: Cash Price |
$815.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$764.90
|
| Rate for Payer: Medical Associates Commercial |
$764.90
|
| Rate for Payer: Midlands Choice Commercial |
$713.90
|
| Rate for Payer: United Healthcare Commercial |
$917.87
|
|
|
liraglutide 18 mg/3 mL Sol [VDMC]
|
Facility
|
OP
|
$1,019.86
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10401086
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$458.94 |
| Max. Negotiated Rate |
$917.87 |
| Rate for Payer: Aetna of IA Commercial |
$917.87
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$917.87
|
| Rate for Payer: Aetna of IA Medicare |
$581.32
|
| Rate for Payer: Amerigroup Medicaid |
$588.26
|
| Rate for Payer: Amerigroup Medicare |
$463.53
|
| Rate for Payer: Cash Price |
$815.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$764.90
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$458.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$582.54
|
| Rate for Payer: Medical Associates Commercial |
$764.90
|
| Rate for Payer: Medical Associates Managed Medicare |
$458.94
|
| Rate for Payer: Midlands Choice Commercial |
$713.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$591.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$527.78
|
| Rate for Payer: United Healthcare Commercial |
$917.87
|
| Rate for Payer: United Healthcare Managed Medicare |
$601.72
|
|
|
lisinopril 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10429571
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of IA Commercial |
$1.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.06
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
|
|
lisinopril 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10429571
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of IA Commercial |
$1.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.06
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.68
|
| Rate for Payer: Amerigroup Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.67
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.53
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.61
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.70
|
|
|
lisinopril 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.67
|
| Rate for Payer: Amerigroup Medicare |
$0.53
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.67
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.53
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.60
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.69
|
|
|
lisinopril 5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401226
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
|
|
lisinopril-HCTZ 20mg-25mg tab [VDMC]
|
Facility
|
IP
|
$1.14
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23268711
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna of IA Commercial |
$1.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.03
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.86
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$0.80
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
|
|
lisinopril-HCTZ 20mg-25mg tab [VDMC]
|
Facility
|
OP
|
$1.14
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23268711
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna of IA Commercial |
$1.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.03
|
| Rate for Payer: Aetna of IA Medicare |
$0.65
|
| Rate for Payer: Amerigroup Medicaid |
$0.66
|
| Rate for Payer: Amerigroup Medicare |
$0.52
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.51
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.51
|
| Rate for Payer: Midlands Choice Commercial |
$0.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.59
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.67
|
|
|
lithium 150 mg Cap [VDMC]
|
Facility
|
OP
|
$1.47
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
18866238
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna of IA Commercial |
$1.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.32
|
| Rate for Payer: Aetna of IA Medicare |
$0.84
|
| Rate for Payer: Amerigroup Medicaid |
$0.85
|
| Rate for Payer: Amerigroup Medicare |
$0.67
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.84
|
| Rate for Payer: Medical Associates Commercial |
$1.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.66
|
| Rate for Payer: Midlands Choice Commercial |
$1.03
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$1.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.87
|
|
|
lithium 150 mg Cap [VDMC]
|
Facility
|
IP
|
$1.47
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
18866238
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna of IA Commercial |
$1.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.32
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.10
|
| Rate for Payer: Medical Associates Commercial |
$1.10
|
| Rate for Payer: Midlands Choice Commercial |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.32
|
|
|
lithium 300 mg Cap [VDMC]
|
Facility
|
OP
|
$1.75
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10401297
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna of IA Commercial |
$1.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.58
|
| Rate for Payer: Aetna of IA Medicare |
$1.00
|
| Rate for Payer: Amerigroup Medicaid |
$1.01
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.00
|
| Rate for Payer: Medical Associates Commercial |
$1.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.79
|
| Rate for Payer: Midlands Choice Commercial |
$1.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.91
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.03
|
|
