|
THERASKIN 1X1
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
8767259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,253.70 |
| Max. Negotiated Rate |
$1,611.90 |
| Rate for Payer: Aetna of IA Commercial |
$1,611.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,432.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,343.25
|
| Rate for Payer: Medical Associates Commercial |
$1,343.25
|
| Rate for Payer: Midlands Choice Commercial |
$1,253.70
|
| Rate for Payer: United Healthcare Commercial |
$1,611.90
|
|
|
THERASKIN 1X2
|
Facility
|
OP
|
$1,944.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
8793727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.61 |
| Max. Negotiated Rate |
$2,069.19 |
| Rate for Payer: Aetna of IA Commercial |
$1,749.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,749.60
|
| Rate for Payer: Aetna of IA Medicare |
$1,108.08
|
| Rate for Payer: Amerigroup Medicaid |
$981.14
|
| Rate for Payer: Amerigroup Medicare |
$981.72
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,458.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$972.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$971.61
|
| Rate for Payer: Medical Associates Commercial |
$1,458.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$972.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,360.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$986.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$986.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,458.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,458.00
|
| Rate for Payer: United Healthcare Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,146.96
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
THERASKIN 1X2
|
Facility
|
IP
|
$1,944.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
8793727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,360.80 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,749.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,749.60
|
| Rate for Payer: Cash Price |
$1,555.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,458.00
|
| Rate for Payer: Medical Associates Commercial |
$1,458.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,360.80
|
| Rate for Payer: United Healthcare Commercial |
$1,749.60
|
|
|
THERA SKIN 2X3
|
Facility
|
IP
|
$2,180.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
8823254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,526.00 |
| Max. Negotiated Rate |
$1,962.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,962.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,962.00
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,635.00
|
| Rate for Payer: Medical Associates Commercial |
$1,635.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,526.00
|
| Rate for Payer: United Healthcare Commercial |
$1,962.00
|
|
|
THERA SKIN 2X3
|
Facility
|
OP
|
$2,180.00
|
|
|
Service Code
|
CPT Q4121
|
| Hospital Charge Code |
8823254
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.56 |
| Max. Negotiated Rate |
$2,069.19 |
| Rate for Payer: Aetna of IA Commercial |
$1,962.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,962.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,242.60
|
| Rate for Payer: Amerigroup Medicaid |
$1,100.25
|
| Rate for Payer: Amerigroup Medicare |
$1,100.90
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Cash Price |
$1,744.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,635.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,090.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,089.56
|
| Rate for Payer: Medical Associates Commercial |
$1,635.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,090.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,526.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,106.35
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1,105.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,635.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,635.00
|
| Rate for Payer: United Healthcare Commercial |
$1,962.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,286.20
|
| Rate for Payer: Wellmark IA HMO |
$1,881.08
|
| Rate for Payer: Wellmark IA PPO |
$2,069.19
|
|
|
THER EXERCISES PER 15 MIN
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
1374020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$81.90 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
|
|
THER EXERCISES PER 15 MIN
|
Facility
|
OP
|
$117.00
|
|
|
Service Code
|
CPT 97110 GP
|
| Hospital Charge Code |
1374020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$58.48 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna of IA Commercial |
$105.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$105.30
|
| Rate for Payer: Aetna of IA Medicare |
$66.69
|
| Rate for Payer: Amerigroup Medicaid |
$59.05
|
| Rate for Payer: Amerigroup Medicare |
$59.08
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$87.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$58.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$58.48
|
| Rate for Payer: Medical Associates Commercial |
$87.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$58.50
|
| Rate for Payer: Midlands Choice Commercial |
$81.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.38
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$59.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$87.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$87.75
|
| Rate for Payer: United Healthcare Commercial |
$105.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.03
|
|
|
THER INJECTION CARP TUNNEL
|
Professional
|
Both
|
$257.00
|
|
|
Service Code
|
CPT 20526
|
| Hospital Charge Code |
7982746
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$179.90 |
| Rate for Payer: Aetna of IA Medicare |
$50.96
|
| Rate for Payer: Amerigroup Medicaid |
$52.69
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Cash Price |
$205.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$91.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.96
|
| Rate for Payer: Midlands Choice Commercial |
$179.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$88.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$76.44
|
|
|
THERMA CHOICE CATHETER
|
Facility
|
OP
|
$1,780.00
|
|
| Hospital Charge Code |
8025932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$889.64 |
| Max. Negotiated Rate |
$1,602.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,602.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,602.00
|
| Rate for Payer: Aetna of IA Medicare |
$1,014.60
|
| Rate for Payer: Amerigroup Medicaid |
$898.37
|
| Rate for Payer: Amerigroup Medicare |
$898.90
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,335.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$890.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$889.64
|
| Rate for Payer: Medical Associates Commercial |
$1,335.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$890.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,246.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$903.35
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$902.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,335.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,335.00
|
| Rate for Payer: United Healthcare Commercial |
$1,602.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,050.20
|
|
|
THERMA CHOICE CATHETER
|
Facility
|
IP
|
$1,780.00
|
|
| Hospital Charge Code |
8025932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.00 |
| Max. Negotiated Rate |
$1,602.00 |
| Rate for Payer: Aetna of IA Commercial |
$1,602.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,602.00
|
| Rate for Payer: Cash Price |
$1,424.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,335.00
|
| Rate for Payer: Medical Associates Commercial |
$1,335.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,246.00
|
| Rate for Payer: United Healthcare Commercial |
$1,602.00
|
|
|
THERMAL ENDOMETR TUMOR ABL
|
Professional
|
Both
|
$3,314.00
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
8069108
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$209.67 |
| Max. Negotiated Rate |
$2,319.80 |
| Rate for Payer: Aetna of IA Medicare |
$209.67
|
| Rate for Payer: Amerigroup Medicaid |
$216.80
|
| Rate for Payer: Cash Price |
$2,651.20
|
| Rate for Payer: Cash Price |
$2,651.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$251.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$213.86
|
| Rate for Payer: Medical Associates Commercial |
$398.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$209.67
|
| Rate for Payer: Midlands Choice Commercial |
$2,319.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$362.73
|
| Rate for Payer: Partners Health Alliance Commercial |
$314.50
|
|
|
thiamine 100 mg/ml 2ml MDV Inj [VDMC]
|
Facility
|
OP
|
$35.04
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
10424876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$31.54 |
| Rate for Payer: Aetna of IA Commercial |
$31.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.54
|
| Rate for Payer: Aetna of IA Medicare |
$19.97
|
| Rate for Payer: Amerigroup Medicaid |
$17.68
|
| Rate for Payer: Amerigroup Medicare |
$17.70
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$17.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$17.51
|
| Rate for Payer: Medical Associates Commercial |
$26.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$17.52
|
| Rate for Payer: Midlands Choice Commercial |
$24.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$17.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$17.77
|
| Rate for Payer: Oscar Health of IA Commercial |
$26.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.28
|
| Rate for Payer: United Healthcare Commercial |
$31.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.67
|
|
|
thiamine 100 mg/ml 2ml MDV Inj [VDMC]
|
Facility
|
IP
|
$35.04
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
10424876
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.53 |
| Max. Negotiated Rate |
$31.54 |
| Rate for Payer: Aetna of IA Commercial |
$31.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.54
|
| Rate for Payer: Cash Price |
$28.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.28
|
| Rate for Payer: Medical Associates Commercial |
$26.28
|
| Rate for Payer: Midlands Choice Commercial |
$24.53
|
| Rate for Payer: United Healthcare Commercial |
$31.54
|
|
|
thiamine 100 mg Tab [VDMC]
|
Facility
|
IP
|
$1.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10424807
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
|
|
thiamine 100 mg Tab [VDMC]
|
Facility
|
OP
|
$1.13
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10424807
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Aetna of IA Commercial |
$1.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.02
|
| Rate for Payer: Aetna of IA Medicare |
$0.64
|
| Rate for Payer: Amerigroup Medicaid |
$0.57
|
| Rate for Payer: Amerigroup Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.56
|
| Rate for Payer: Medical Associates Commercial |
$0.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.57
|
| Rate for Payer: Midlands Choice Commercial |
$0.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.57
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.67
|
|
|
Thoracentesis Procedure
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
8060785
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$369.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Aetna of IA Commercial |
$475.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$475.20
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$396.00
|
| Rate for Payer: Medical Associates Commercial |
$396.00
|
| Rate for Payer: Midlands Choice Commercial |
$369.60
|
| Rate for Payer: United Healthcare Commercial |
$475.20
|
|
|
Thoracentesis Procedure
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
8060785
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$263.89 |
| Max. Negotiated Rate |
$1,703.64 |
| Rate for Payer: Aetna of IA Commercial |
$475.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$475.20
|
| Rate for Payer: Aetna of IA Medicare |
$300.96
|
| Rate for Payer: Amerigroup Medicaid |
$266.48
|
| Rate for Payer: Amerigroup Medicare |
$266.64
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$396.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$264.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$263.89
|
| Rate for Payer: Medical Associates Commercial |
$396.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$264.00
|
| Rate for Payer: Midlands Choice Commercial |
$369.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$267.96
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$267.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$396.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$396.00
|
| Rate for Payer: United Healthcare Commercial |
$475.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$311.52
|
| Rate for Payer: Wellmark IA HMO |
$1,548.76
|
| Rate for Payer: Wellmark IA PPO |
$1,703.64
|
|
|
THP Albuterol Inhaler [VDMC]
|
Facility
|
OP
|
$82.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10735590
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.42 |
| Max. Negotiated Rate |
$74.59 |
| Rate for Payer: Aetna of IA Commercial |
$74.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.59
|
| Rate for Payer: Aetna of IA Medicare |
$47.24
|
| Rate for Payer: Amerigroup Medicaid |
$41.83
|
| Rate for Payer: Amerigroup Medicare |
$41.85
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$41.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$41.42
|
| Rate for Payer: Medical Associates Commercial |
$62.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$41.44
|
| Rate for Payer: Midlands Choice Commercial |
$58.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$42.06
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$42.04
|
| Rate for Payer: Oscar Health of IA Commercial |
$62.16
|
| Rate for Payer: Partners Health Alliance Commercial |
$62.16
|
| Rate for Payer: United Healthcare Commercial |
$74.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.90
|
|
|
THP Albuterol Inhaler [VDMC]
|
Facility
|
IP
|
$82.88
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10735590
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$58.02 |
| Max. Negotiated Rate |
$74.59 |
| Rate for Payer: Aetna of IA Commercial |
$74.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$74.59
|
| Rate for Payer: Cash Price |
$66.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$62.16
|
| Rate for Payer: Medical Associates Commercial |
$62.16
|
| Rate for Payer: Midlands Choice Commercial |
$58.02
|
| Rate for Payer: United Healthcare Commercial |
$74.59
|
|
|
THP albuterol-ipratropium 0.5mg/3mg neb sol 3mL SDV [VDMC]
|
Facility
|
IP
|
$10.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
26928539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna of IA Commercial |
$9.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.29
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.74
|
| Rate for Payer: Medical Associates Commercial |
$7.74
|
| Rate for Payer: Midlands Choice Commercial |
$7.22
|
| Rate for Payer: United Healthcare Commercial |
$9.29
|
|
|
THP albuterol-ipratropium 0.5mg/3mg neb sol 3mL SDV [VDMC]
|
Facility
|
OP
|
$10.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
26928539
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna of IA Commercial |
$9.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.29
|
| Rate for Payer: Aetna of IA Medicare |
$5.88
|
| Rate for Payer: Amerigroup Medicaid |
$5.21
|
| Rate for Payer: Amerigroup Medicare |
$5.21
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.16
|
| Rate for Payer: Medical Associates Commercial |
$7.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.16
|
| Rate for Payer: Midlands Choice Commercial |
$7.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$5.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$7.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.74
|
| Rate for Payer: United Healthcare Commercial |
$9.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.09
|
|
|
THP amoxicillin 400 mg/5 mL Oral Liq 50ml [VDMC]
|
Facility
|
IP
|
$22.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10366522
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.62 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna of IA Commercial |
$20.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.09
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.74
|
| Rate for Payer: Medical Associates Commercial |
$16.74
|
| Rate for Payer: Midlands Choice Commercial |
$15.62
|
| Rate for Payer: United Healthcare Commercial |
$20.09
|
|
|
THP amoxicillin 400 mg/5 mL Oral Liq 50ml [VDMC]
|
Facility
|
OP
|
$22.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10366522
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna of IA Commercial |
$20.09
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.09
|
| Rate for Payer: Aetna of IA Medicare |
$12.72
|
| Rate for Payer: Amerigroup Medicaid |
$11.26
|
| Rate for Payer: Amerigroup Medicare |
$11.27
|
| Rate for Payer: Cash Price |
$17.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$16.74
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.16
|
| Rate for Payer: Medical Associates Commercial |
$16.74
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.16
|
| Rate for Payer: Midlands Choice Commercial |
$15.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.33
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$11.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$16.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.74
|
| Rate for Payer: United Healthcare Commercial |
$20.09
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.17
|
|
|
THP Amoxicillin 500mg 6 capsules [VDMC]
|
Facility
|
OP
|
$12.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10735809
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Aetna of IA Commercial |
$11.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.38
|
| Rate for Payer: Aetna of IA Medicare |
$7.20
|
| Rate for Payer: Amerigroup Medicaid |
$6.38
|
| Rate for Payer: Amerigroup Medicare |
$6.38
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.32
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.32
|
| Rate for Payer: Medical Associates Commercial |
$9.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.32
|
| Rate for Payer: Midlands Choice Commercial |
$8.85
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.41
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$6.41
|
| Rate for Payer: Oscar Health of IA Commercial |
$9.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.48
|
| Rate for Payer: United Healthcare Commercial |
$11.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.46
|
|
|
THP Amoxicillin 500mg 6 capsules [VDMC]
|
Facility
|
IP
|
$12.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10735809
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$11.38 |
| Rate for Payer: Aetna of IA Commercial |
$11.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.38
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.48
|
| Rate for Payer: Medical Associates Commercial |
$9.48
|
| Rate for Payer: Midlands Choice Commercial |
$8.85
|
| Rate for Payer: United Healthcare Commercial |
$11.38
|
|
