|
TELEHEALTH FACILITY FEE
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT Q3014
|
| Hospital Charge Code |
7855053
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$100.25 |
| Rate for Payer: Aetna of IA Commercial |
$58.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.50
|
| Rate for Payer: Aetna of IA Medicare |
$37.05
|
| Rate for Payer: Amerigroup Medicaid |
$32.81
|
| Rate for Payer: Amerigroup Medicare |
$32.82
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.49
|
| Rate for Payer: Medical Associates Commercial |
$48.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.50
|
| Rate for Payer: Midlands Choice Commercial |
$45.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.99
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$32.97
|
| Rate for Payer: Oscar Health of IA Commercial |
$48.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.75
|
| Rate for Payer: United Healthcare Commercial |
$58.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.35
|
| Rate for Payer: Wellmark IA HMO |
$91.14
|
| Rate for Payer: Wellmark IA PPO |
$100.25
|
|
|
Telemetry
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
7466783
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$9,842.42 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,258.00
|
| Rate for Payer: Amerigroup Medicare |
$2,054.34
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,034.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$9,842.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,051.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,339.10
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,306.00
|
|
|
Telemetry
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
7466783
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$114.95 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$131.10
|
| Rate for Payer: Amerigroup Medicaid |
$116.08
|
| Rate for Payer: Amerigroup Medicare |
$116.15
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$115.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.95
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$115.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$116.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$116.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$172.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.50
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
|
|
Telemetry Daily Charge
|
Facility
|
IP
|
$230.00
|
|
| Hospital Charge Code |
7863885
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$9,842.42 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,258.00
|
| Rate for Payer: Amerigroup Medicare |
$2,054.34
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,034.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$9,842.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$3,051.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,339.10
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,306.00
|
|
|
Telemetry Daily Charge
|
Facility
|
OP
|
$230.00
|
|
| Hospital Charge Code |
7863885
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$114.95 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna of IA Commercial |
$207.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$207.00
|
| Rate for Payer: Aetna of IA Medicare |
$131.10
|
| Rate for Payer: Amerigroup Medicaid |
$116.08
|
| Rate for Payer: Amerigroup Medicare |
$116.15
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$172.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$115.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.95
|
| Rate for Payer: Medical Associates Commercial |
$172.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$115.00
|
| Rate for Payer: Midlands Choice Commercial |
$161.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$116.72
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$116.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$172.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$172.50
|
| Rate for Payer: United Healthcare Commercial |
$207.00
|
|
|
telmisartan 40 mg Tab [VDMC]
|
Facility
|
IP
|
$2.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10608819
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
|
telmisartan 40 mg Tab [VDMC]
|
Facility
|
OP
|
$2.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10608819
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$1.33
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.97
|
| 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
|
|
|
temazepam 15 mg Cap [VDMC]
|
Facility
|
IP
|
$3.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10423701
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of IA Commercial |
$2.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.96
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.47
|
| Rate for Payer: Medical Associates Commercial |
$2.47
|
| Rate for Payer: Midlands Choice Commercial |
$2.30
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
|
|
temazepam 15 mg Cap [VDMC]
|
Facility
|
OP
|
$3.29
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10423701
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna of IA Commercial |
$2.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.96
|
| Rate for Payer: Aetna of IA Medicare |
$1.88
|
| Rate for Payer: Amerigroup Medicaid |
$1.66
|
| Rate for Payer: Amerigroup Medicare |
$1.66
|
| Rate for Payer: Cash Price |
$2.63
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.47
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.64
|
| Rate for Payer: Medical Associates Commercial |
$2.47
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.64
|
| Rate for Payer: Midlands Choice Commercial |
$2.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.67
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.47
|
| Rate for Payer: United Healthcare Commercial |
$2.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.94
|
|
|
TEMP EXTERNAL PACING
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
CPT 92953
|
| Hospital Charge Code |
7982757
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna of IA Medicare |
$0.78
|
| Rate for Payer: Amerigroup Medicaid |
$0.81
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.80
|
| Rate for Payer: Medical Associates Commercial |
$1.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.78
|
| Rate for Payer: Midlands Choice Commercial |
$2.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.17
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
7982929
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
TEMPORAL ARTERY PROCEDURE
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
7982929
|
|
Hospital Revenue Code
|
450
|
| 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: Molina Healthcare Managed Medicare |
$413.37
|
| Rate for Payer: Oscar Health of IA Commercial |
$611.25
|
| 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
|
|
|
TENDON GRACILIS
|
Facility
|
OP
|
$2,835.00
|
|
| Hospital Charge Code |
8047299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,416.93 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,615.95
|
| Rate for Payer: Amerigroup Medicaid |
$1,430.82
|
| Rate for Payer: Amerigroup Medicare |
$1,431.68
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,417.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,416.93
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,417.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,438.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,437.91
|
| Rate for Payer: Oscar Health of IA Commercial |
$2,126.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,126.25
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,672.65
|
|
|
TENDON GRACILIS
|
Facility
|
IP
|
$2,835.00
|
|
| Hospital Charge Code |
8047299
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.50 |
| Max. Negotiated Rate |
$2,551.50 |
| Rate for Payer: Aetna of IA Commercial |
$2,551.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,551.50
|
| Rate for Payer: Cash Price |
$2,268.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,126.25
|
| Rate for Payer: Medical Associates Commercial |
$2,126.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,984.50
|
| Rate for Payer: United Healthcare Commercial |
$2,551.50
|
|
|
Tendonitis, Myositis and Bursitis With MCC
|
Facility
|
IP
|
$8,619.99
|
|
|
Service Code
|
MS-DRG 557
|
| Hospital Charge Code |
364
|
| Min. Negotiated Rate |
$8,495.06 |
| Max. Negotiated Rate |
$8,619.99 |
| Rate for Payer: Amerigroup Medicaid |
$8,578.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,495.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,619.99
|
|
|
Tendonitis, Myositis and Bursitis Without MCC
|
Facility
|
IP
|
$6,202.69
|
|
|
Service Code
|
MS-DRG 558
|
| Hospital Charge Code |
365
|
| Min. Negotiated Rate |
$6,112.80 |
| Max. Negotiated Rate |
$6,202.69 |
| Rate for Payer: Amerigroup Medicaid |
$6,172.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,112.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,202.69
|
|
|
tenecteplase 50 mg IV SDV Inj [VDMC]
|
Facility
|
OP
|
$14,118.70
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
10423770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7,056.53 |
| Max. Negotiated Rate |
$12,706.83 |
| Rate for Payer: Aetna of IA Commercial |
$12,706.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12,706.83
|
| Rate for Payer: Aetna of IA Medicare |
$8,047.66
|
| Rate for Payer: Amerigroup Medicaid |
$7,125.71
|
| Rate for Payer: Amerigroup Medicare |
$7,129.94
|
| Rate for Payer: Cash Price |
$11,294.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10,589.02
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7,059.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,056.53
|
| Rate for Payer: Medical Associates Commercial |
$10,589.02
|
| Rate for Payer: Medical Associates Managed Medicare |
$7,059.35
|
| Rate for Payer: Midlands Choice Commercial |
$9,883.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,165.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$7,161.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$10,589.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$10,589.02
|
| Rate for Payer: United Healthcare Commercial |
$12,706.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$8,330.03
|
|
|
tenecteplase 50 mg IV SDV Inj [VDMC]
|
Facility
|
IP
|
$14,118.70
|
|
|
Service Code
|
HCPCS J3101
|
| Hospital Charge Code |
10423770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9,883.09 |
| Max. Negotiated Rate |
$12,706.83 |
| Rate for Payer: Aetna of IA Commercial |
$12,706.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12,706.83
|
| Rate for Payer: Cash Price |
$11,294.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10,589.02
|
| Rate for Payer: Medical Associates Commercial |
$10,589.02
|
| Rate for Payer: Midlands Choice Commercial |
$9,883.09
|
| Rate for Payer: United Healthcare Commercial |
$12,706.83
|
|
|
terazosin 1 mg Cap [VDMC]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10423837
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna of IA Commercial |
$1.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.31
|
| Rate for Payer: Aetna of IA Medicare |
$0.83
|
| Rate for Payer: Amerigroup Medicaid |
$0.74
|
| Rate for Payer: Amerigroup Medicare |
$0.74
|
| 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 |
$0.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.73
|
| Rate for Payer: Medical Associates Commercial |
$1.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.73
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.74
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.74
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.86
|
|
|
terazosin 1 mg Cap [VDMC]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10423837
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna of IA Commercial |
$1.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.31
|
| 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 |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
|
|
terazosin 5 mg Cap [VDMC]
|
Facility
|
OP
|
$1.49
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10423906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna of IA Commercial |
$1.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.34
|
| Rate for Payer: Aetna of IA Medicare |
$0.85
|
| Rate for Payer: Amerigroup Medicaid |
$0.75
|
| Rate for Payer: Amerigroup Medicare |
$0.75
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.74
|
| Rate for Payer: Medical Associates Commercial |
$1.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.75
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.76
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$1.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.88
|
|
|
terazosin 5 mg Cap [VDMC]
|
Facility
|
IP
|
$1.49
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10423906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.34 |
| Rate for Payer: Aetna of IA Commercial |
$1.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.34
|
| Rate for Payer: Cash Price |
$1.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.12
|
| Rate for Payer: Medical Associates Commercial |
$1.12
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.34
|
|
|
terbinafine 250 mg Tab [VDMC]
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10423975
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna of IA Commercial |
$1.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.86
|
| Rate for Payer: Aetna of IA Medicare |
$1.18
|
| Rate for Payer: Amerigroup Medicaid |
$1.04
|
| Rate for Payer: Amerigroup Medicare |
$1.05
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.03
|
| Rate for Payer: Medical Associates Commercial |
$1.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.04
|
| Rate for Payer: Midlands Choice Commercial |
$1.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.55
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.22
|
|
|
terbinafine 250 mg Tab [VDMC]
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10423975
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna of IA Commercial |
$1.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.86
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.55
|
| Rate for Payer: Medical Associates Commercial |
$1.55
|
| Rate for Payer: Midlands Choice Commercial |
$1.45
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
|
|
terbinafine topical 1% Cre 15gm [VDMC]
|
Facility
|
OP
|
$33.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11337009
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$29.81 |
| Rate for Payer: Aetna of IA Commercial |
$29.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.81
|
| Rate for Payer: Aetna of IA Medicare |
$18.88
|
| Rate for Payer: Amerigroup Medicaid |
$16.72
|
| Rate for Payer: Amerigroup Medicare |
$16.73
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.55
|
| Rate for Payer: Medical Associates Commercial |
$24.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.56
|
| Rate for Payer: Midlands Choice Commercial |
$23.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$16.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.84
|
| Rate for Payer: United Healthcare Commercial |
$29.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.54
|
|
