|
TIGER CANULATED SCREW 4.0MMX42MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8810196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna of IA Commercial |
$160.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$160.20
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$133.50
|
| Rate for Payer: Medical Associates Commercial |
$133.50
|
| Rate for Payer: Midlands Choice Commercial |
$124.60
|
| Rate for Payer: United Healthcare Commercial |
$160.20
|
|
|
TIGERTAPE
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
|
|
TIGERTAPE
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$218.70 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Aetna of IA Medicare |
$277.02
|
| Rate for Payer: Amerigroup Medicaid |
$280.32
|
| Rate for Payer: Amerigroup Medicare |
$220.89
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$218.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$277.60
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$218.70
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$281.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$251.50
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$286.74
|
|
|
tildrakizumab-asmn 100 mg/mL Syringe PFS [VDMC]
|
Facility
|
IP
|
$36,022.88
|
|
|
Service Code
|
HCPCS J3245
|
| Hospital Charge Code |
24914770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25,216.02 |
| Max. Negotiated Rate |
$32,420.59 |
| Rate for Payer: Aetna of IA Commercial |
$32,420.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32,420.59
|
| Rate for Payer: Cash Price |
$28,818.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27,017.16
|
| Rate for Payer: Medical Associates Commercial |
$27,017.16
|
| Rate for Payer: Midlands Choice Commercial |
$25,216.02
|
| Rate for Payer: United Healthcare Commercial |
$32,420.59
|
|
|
tildrakizumab-asmn 100 mg/mL Syringe PFS [VDMC]
|
Facility
|
OP
|
$36,022.88
|
|
|
Service Code
|
HCPCS J3245
|
| Hospital Charge Code |
24914770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16,210.30 |
| Max. Negotiated Rate |
$32,420.59 |
| Rate for Payer: Aetna of IA Commercial |
$32,420.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32,420.59
|
| Rate for Payer: Aetna of IA Medicare |
$20,533.04
|
| Rate for Payer: Amerigroup Medicaid |
$20,778.00
|
| Rate for Payer: Amerigroup Medicare |
$16,372.40
|
| Rate for Payer: Cash Price |
$28,818.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27,017.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16,210.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20,576.27
|
| Rate for Payer: Medical Associates Commercial |
$27,017.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$16,210.30
|
| Rate for Payer: Midlands Choice Commercial |
$25,216.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,878.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$18,641.84
|
| Rate for Payer: United Healthcare Commercial |
$32,420.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$21,253.50
|
|
|
Timolol Maleate Ophth 0.5% 5 ml Sol [VDMC]
|
Facility
|
IP
|
$35.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439520
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.95 |
| Max. Negotiated Rate |
$32.08 |
| Rate for Payer: Aetna of IA Commercial |
$32.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.08
|
| Rate for Payer: Cash Price |
$28.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.73
|
| Rate for Payer: Medical Associates Commercial |
$26.73
|
| Rate for Payer: Midlands Choice Commercial |
$24.95
|
| Rate for Payer: United Healthcare Commercial |
$32.08
|
|
|
Timolol Maleate Ophth 0.5% 5 ml Sol [VDMC]
|
Facility
|
OP
|
$35.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439520
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$32.08 |
| Rate for Payer: Aetna of IA Commercial |
$32.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.08
|
| Rate for Payer: Aetna of IA Medicare |
$20.31
|
| Rate for Payer: Amerigroup Medicaid |
$20.56
|
| Rate for Payer: Amerigroup Medicare |
$16.20
|
| Rate for Payer: Cash Price |
$28.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.36
|
| Rate for Payer: Medical Associates Commercial |
$26.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.04
|
| Rate for Payer: Midlands Choice Commercial |
$24.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.44
|
| Rate for Payer: United Healthcare Commercial |
$32.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.03
|
|
|
timolol Ophth 0.25% 5ml Sol [VDMC]
|
Facility
|
OP
|
$24.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of IA Commercial |
$21.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.74
|
| Rate for Payer: Aetna of IA Medicare |
$13.77
|
| Rate for Payer: Amerigroup Medicaid |
$13.94
|
| Rate for Payer: Amerigroup Medicare |
$10.98
|
| Rate for Payer: Cash Price |
$19.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.80
|
| Rate for Payer: Medical Associates Commercial |
$18.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.87
|
| Rate for Payer: Midlands Choice Commercial |
$16.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.50
|
| Rate for Payer: United Healthcare Commercial |
$21.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.25
|
|
|
timolol Ophth 0.25% 5ml Sol [VDMC]
|
Facility
|
IP
|
$24.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of IA Commercial |
$21.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.74
|
| Rate for Payer: Cash Price |
$19.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.12
|
| Rate for Payer: Medical Associates Commercial |
$18.12
|
| Rate for Payer: Midlands Choice Commercial |
$16.91
|
| Rate for Payer: United Healthcare Commercial |
$21.74
|
|
|
timolol ophthalmic maleate 0.5% Sol 2.5ml [VDMC]
|
Facility
|
IP
|
$295.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20409234
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$206.72 |
| Max. Negotiated Rate |
$265.79 |
| Rate for Payer: Aetna of IA Commercial |
$265.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$265.79
|
| Rate for Payer: Cash Price |
$236.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$221.49
|
| Rate for Payer: Medical Associates Commercial |
$221.49
|
| Rate for Payer: Midlands Choice Commercial |
$206.72
|
| Rate for Payer: United Healthcare Commercial |
$265.79
|
|
|
timolol ophthalmic maleate 0.5% Sol 2.5ml [VDMC]
|
Facility
|
OP
|
$295.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
20409234
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$132.89 |
| Max. Negotiated Rate |
$265.79 |
| Rate for Payer: Aetna of IA Commercial |
$265.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$265.79
|
| Rate for Payer: Aetna of IA Medicare |
$168.33
|
| Rate for Payer: Amerigroup Medicaid |
$170.34
|
| Rate for Payer: Amerigroup Medicare |
$134.22
|
| Rate for Payer: Cash Price |
$236.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$221.49
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$132.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$168.69
|
| Rate for Payer: Medical Associates Commercial |
$221.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$132.89
|
| Rate for Payer: Midlands Choice Commercial |
$206.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$171.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$152.83
|
| Rate for Payer: United Healthcare Commercial |
$265.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$174.24
|
|
|
tiotropium 18 mcg Inh Cap [VDMC]
|
Facility
|
OP
|
$199.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425225
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$89.78 |
| Max. Negotiated Rate |
$179.57 |
| Rate for Payer: Aetna of IA Commercial |
$179.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$179.57
|
| Rate for Payer: Aetna of IA Medicare |
$113.73
|
| Rate for Payer: Amerigroup Medicaid |
$115.08
|
| Rate for Payer: Amerigroup Medicare |
$90.68
|
| Rate for Payer: Cash Price |
$159.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$149.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.78
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.97
|
| Rate for Payer: Medical Associates Commercial |
$149.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.78
|
| Rate for Payer: Midlands Choice Commercial |
$139.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$115.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$103.25
|
| Rate for Payer: United Healthcare Commercial |
$179.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$117.72
|
|
|
tiotropium 18 mcg Inh Cap [VDMC]
|
Facility
|
IP
|
$199.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425225
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$139.66 |
| Max. Negotiated Rate |
$179.57 |
| Rate for Payer: Aetna of IA Commercial |
$179.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$179.57
|
| Rate for Payer: Cash Price |
$159.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$149.64
|
| Rate for Payer: Medical Associates Commercial |
$149.64
|
| Rate for Payer: Midlands Choice Commercial |
$139.66
|
| Rate for Payer: United Healthcare Commercial |
$179.57
|
|
|
tirofiban 50 mcg/mL 250ml SD Sol [VDMC]
|
Facility
|
IP
|
$505.30
|
|
|
Service Code
|
HCPCS J3246
|
| Hospital Charge Code |
11224748
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$353.71 |
| Max. Negotiated Rate |
$454.77 |
| Rate for Payer: Aetna of IA Commercial |
$454.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$454.77
|
| Rate for Payer: Cash Price |
$404.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.98
|
| Rate for Payer: Medical Associates Commercial |
$378.98
|
| Rate for Payer: Midlands Choice Commercial |
$353.71
|
| Rate for Payer: United Healthcare Commercial |
$454.77
|
|
|
tirofiban 50 mcg/mL 250ml SD Sol [VDMC]
|
Facility
|
OP
|
$505.30
|
|
|
Service Code
|
HCPCS J3246
|
| Hospital Charge Code |
11224748
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$227.38 |
| Max. Negotiated Rate |
$454.77 |
| Rate for Payer: Aetna of IA Commercial |
$454.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$454.77
|
| Rate for Payer: Aetna of IA Medicare |
$288.02
|
| Rate for Payer: Amerigroup Medicaid |
$291.46
|
| Rate for Payer: Amerigroup Medicare |
$229.66
|
| Rate for Payer: Cash Price |
$404.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$378.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$227.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$288.63
|
| Rate for Payer: Medical Associates Commercial |
$378.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$227.38
|
| Rate for Payer: Midlands Choice Commercial |
$353.71
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$292.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$261.49
|
| Rate for Payer: United Healthcare Commercial |
$454.77
|
| Rate for Payer: United Healthcare Managed Medicare |
$298.13
|
|
|
Tissue Transglutaminase IgA Ab DMCL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037815
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$63.45
|
| Rate for Payer: Amerigroup Medicare |
$49.99
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.83
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.92
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
|
|
Tissue Transglutaminase IgA Ab DMCL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037815
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
Tissue Transglutaminase IgG Ab DMCL
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
|
|
Tissue Transglutaminase IgG Ab DMCL
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
8037816
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.50 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Aetna of IA Commercial |
$99.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.00
|
| Rate for Payer: Aetna of IA Medicare |
$62.70
|
| Rate for Payer: Amerigroup Medicaid |
$63.45
|
| Rate for Payer: Amerigroup Medicare |
$49.99
|
| Rate for Payer: Cash Price |
$88.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$82.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.83
|
| Rate for Payer: Medical Associates Commercial |
$82.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$77.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$63.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.92
|
| Rate for Payer: United Healthcare Commercial |
$99.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.90
|
|
|
TIS TRNFR E/N/E/L 10 SQ CM/<
|
Facility
|
OP
|
$2,919.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
7982914
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,313.55 |
| Max. Negotiated Rate |
$2,627.10 |
| Rate for Payer: Aetna of IA Commercial |
$2,627.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,627.10
|
| Rate for Payer: Aetna of IA Medicare |
$1,663.83
|
| Rate for Payer: Amerigroup Medicaid |
$1,683.68
|
| Rate for Payer: Amerigroup Medicare |
$1,326.69
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,189.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,313.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,667.33
|
| Rate for Payer: Medical Associates Commercial |
$2,189.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,313.55
|
| Rate for Payer: Midlands Choice Commercial |
$2,043.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,691.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,510.58
|
| Rate for Payer: United Healthcare Commercial |
$2,627.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,722.21
|
|
|
TIS TRNFR E/N/E/L 10 SQ CM/<
|
Facility
|
IP
|
$2,919.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
7982914
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$2,627.10 |
| Rate for Payer: Aetna of IA Commercial |
$2,627.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,627.10
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,189.25
|
| Rate for Payer: Medical Associates Commercial |
$2,189.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,043.30
|
| Rate for Payer: United Healthcare Commercial |
$2,627.10
|
|
|
TIS TRNFR F/C/C/M/N/A/G/H/F
|
Facility
|
OP
|
$2,919.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
7982913
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,313.55 |
| Max. Negotiated Rate |
$2,627.10 |
| Rate for Payer: Aetna of IA Commercial |
$2,627.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,627.10
|
| Rate for Payer: Aetna of IA Medicare |
$1,663.83
|
| Rate for Payer: Amerigroup Medicaid |
$1,683.68
|
| Rate for Payer: Amerigroup Medicare |
$1,326.69
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,189.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,313.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,667.33
|
| Rate for Payer: Medical Associates Commercial |
$2,189.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,313.55
|
| Rate for Payer: Midlands Choice Commercial |
$2,043.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,691.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,510.58
|
| Rate for Payer: United Healthcare Commercial |
$2,627.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,722.21
|
|
|
TIS TRNFR F/C/C/M/N/A/G/H/F
|
Facility
|
IP
|
$2,919.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
7982913
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$2,627.10 |
| Rate for Payer: Aetna of IA Commercial |
$2,627.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,627.10
|
| Rate for Payer: Cash Price |
$2,335.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2,189.25
|
| Rate for Payer: Medical Associates Commercial |
$2,189.25
|
| Rate for Payer: Midlands Choice Commercial |
$2,043.30
|
| Rate for Payer: United Healthcare Commercial |
$2,627.10
|
|
|
tiZANidine 4 mg Tab [VDMC]
|
Facility
|
OP
|
$2.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna of IA Commercial |
$2.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.23
|
| Rate for Payer: Aetna of IA Medicare |
$1.42
|
| Rate for Payer: Amerigroup Medicaid |
$1.43
|
| Rate for Payer: Amerigroup Medicare |
$1.13
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.42
|
| Rate for Payer: Medical Associates Commercial |
$1.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.12
|
| Rate for Payer: Midlands Choice Commercial |
$1.74
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.29
|
| Rate for Payer: United Healthcare Commercial |
$2.23
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.47
|
|
|
tiZANidine 4 mg Tab [VDMC]
|
Facility
|
IP
|
$2.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425290
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna of IA Commercial |
$2.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.23
|
| Rate for Payer: Cash Price |
$1.99
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.86
|
| Rate for Payer: Medical Associates Commercial |
$1.86
|
| Rate for Payer: Midlands Choice Commercial |
$1.74
|
| Rate for Payer: United Healthcare Commercial |
$2.23
|
|
