|
traMADol 50 mg Tab
|
Facility
IP
|
$3.36
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
43700109
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna of IA Commercial |
$3.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.02
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.52
|
| Rate for Payer: Medical Associates Commercial |
$2.52
|
| Rate for Payer: Midlands Choice Commercial |
$2.35
|
| Rate for Payer: United Healthcare Commercial |
$3.02
|
|
|
tranexamic acid 100 mg/mL 10 ml SDV INJ
|
Facility
IP
|
$32.88
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.02 |
| Max. Negotiated Rate |
$29.59 |
| Rate for Payer: Aetna of IA Commercial |
$29.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.59
|
| Rate for Payer: Cash Price |
$26.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.66
|
| Rate for Payer: Medical Associates Commercial |
$24.66
|
| Rate for Payer: Midlands Choice Commercial |
$23.02
|
| Rate for Payer: United Healthcare Commercial |
$29.59
|
|
|
tranexamic acid 100 mg/mL 10 ml SDV INJ
|
Facility
OP
|
$32.88
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43700307
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.43 |
| Max. Negotiated Rate |
$29.59 |
| Rate for Payer: Aetna of IA Commercial |
$29.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.59
|
| Rate for Payer: Aetna of IA Medicare |
$18.74
|
| Rate for Payer: Amerigroup Medicaid |
$16.59
|
| Rate for Payer: Amerigroup Medicare |
$16.60
|
| Rate for Payer: Cash Price |
$26.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.66
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.43
|
| Rate for Payer: Medical Associates Commercial |
$24.66
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.44
|
| Rate for Payer: Midlands Choice Commercial |
$23.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.66
|
| Rate for Payer: United Healthcare Commercial |
$29.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.40
|
|
|
tranexamic acid 650 mg Tab
|
Facility
OP
|
$11.23
|
|
|
Service Code
|
CPT J9355
|
| Hospital Charge Code |
43700476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Aetna of IA Commercial |
$10.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.11
|
| Rate for Payer: Aetna of IA Medicare |
$6.40
|
| Rate for Payer: Amerigroup Medicaid |
$5.67
|
| Rate for Payer: Amerigroup Medicare |
$5.67
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.61
|
| Rate for Payer: Medical Associates Commercial |
$8.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.62
|
| Rate for Payer: Midlands Choice Commercial |
$7.86
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$8.42
|
| Rate for Payer: United Healthcare Commercial |
$10.11
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.63
|
|
|
tranexamic acid 650 mg Tab
|
Facility
IP
|
$11.23
|
|
|
Service Code
|
CPT J9355
|
| Hospital Charge Code |
43700476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Aetna of IA Commercial |
$10.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.11
|
| Rate for Payer: Cash Price |
$8.98
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.42
|
| Rate for Payer: Medical Associates Commercial |
$8.42
|
| Rate for Payer: Midlands Choice Commercial |
$7.86
|
| Rate for Payer: United Healthcare Commercial |
$10.11
|
|
|
TRANSCUTANEOUS BILI
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
4882833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
TRANSCUTANEOUS BILI
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
4882833
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
TRANSCUTANEOUS BILI
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
8027044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
TRANSCUTANEOUS BILI
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
1099777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
TRANSCUTANEOUS BILI
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
1099777
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.70 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
|
|
TRANSCUTANEOUS BILI
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
8027044
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$54.90 |
| Rate for Payer: Aetna of IA Commercial |
$54.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.90
|
| Rate for Payer: Aetna of IA Medicare |
$34.77
|
| Rate for Payer: Amerigroup Medicaid |
$30.79
|
| Rate for Payer: Amerigroup Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$30.49
|
| Rate for Payer: Medical Associates Commercial |
$45.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.50
|
| Rate for Payer: Midlands Choice Commercial |
$42.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.75
|
| Rate for Payer: United Healthcare Commercial |
$54.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.99
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
Transferrin DMCL
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
8037819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Aetna of IA Medicare |
$59.28
|
| Rate for Payer: Amerigroup Medicaid |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$52.52
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$52.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$52.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$78.00
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.36
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
Transferrin DMCL
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
8037819
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Aetna of IA Commercial |
$93.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$93.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.00
|
| Rate for Payer: Medical Associates Commercial |
$78.00
|
| Rate for Payer: Midlands Choice Commercial |
$72.80
|
| Rate for Payer: United Healthcare Commercial |
$93.60
|
|
|
Transient Ischemia Without Thrombolytic
|
Facility
IP
|
$6,229.26
|
|
|
Service Code
|
MS-DRG 069
|
| Hospital Charge Code |
749
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,229.26 |
| Rate for Payer: Amerigroup Medicaid |
$6,199.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,138.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,229.26
|
|
|
Transurethral Procedures With CC
|
Facility
IP
|
$13,491.98
|
|
|
Service Code
|
MS-DRG 669
|
| Hospital Charge Code |
451
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$13,491.98 |
| Rate for Payer: Amerigroup Medicaid |
$13,426.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13,296.44
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13,491.98
|
|
|
Transurethral Procedures With MCC
|
Facility
IP
|
$15,699.64
|
|
|
Service Code
|
MS-DRG 668
|
| Hospital Charge Code |
450
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$15,699.64 |
| Rate for Payer: Amerigroup Medicaid |
$15,623.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15,472.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,699.64
|
|
|
Transurethral Procedures Without CC/MCC
|
Facility
IP
|
$7,947.75
|
|
|
Service Code
|
MS-DRG 670
|
| Hospital Charge Code |
452
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,947.75 |
| Rate for Payer: Amerigroup Medicaid |
$7,909.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,832.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,947.75
|
|
|
Transurethral Prostatectomy With CC/MCC
|
Facility
IP
|
$9,469.39
|
|
|
Service Code
|
MS-DRG 713
|
| Hospital Charge Code |
480
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$9,469.39 |
| Rate for Payer: Amerigroup Medicaid |
$9,423.65
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,332.15
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,469.39
|
|
|
Transurethral Prostatectomy Without CC/MCC
|
Facility
IP
|
$7,155.43
|
|
|
Service Code
|
MS-DRG 714
|
| Hospital Charge Code |
481
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$7,155.43 |
| Rate for Payer: Amerigroup Medicaid |
$7,120.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,051.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,155.43
|
|
|
Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)
|
Facility
OP
|
$703.14
|
|
|
Service Code
|
CPT 64486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$639.22 |
| Max. Negotiated Rate |
$703.14 |
| Rate for Payer: Wellmark IA HMO |
$639.22
|
| Rate for Payer: Wellmark IA PPO |
$703.14
|
|
|
trastuzumab 150 mg Pow SDV
|
Facility
IP
|
$6,283.68
|
|
|
Service Code
|
CPT Q5112
|
| Hospital Charge Code |
43700557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4,398.58 |
| Max. Negotiated Rate |
$5,655.31 |
| Rate for Payer: Aetna of IA Commercial |
$5,655.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,655.31
|
| Rate for Payer: Cash Price |
$5,026.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,712.76
|
| Rate for Payer: Medical Associates Commercial |
$4,712.76
|
| Rate for Payer: Midlands Choice Commercial |
$4,398.58
|
| Rate for Payer: United Healthcare Commercial |
$5,655.31
|
|
|
trastuzumab 150 mg Pow SDV
|
Facility
OP
|
$6,283.68
|
|
|
Service Code
|
CPT Q5112
|
| Hospital Charge Code |
43700557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,140.58 |
| Max. Negotiated Rate |
$5,655.31 |
| Rate for Payer: Aetna of IA Commercial |
$5,655.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,655.31
|
| Rate for Payer: Aetna of IA Medicare |
$3,581.70
|
| Rate for Payer: Amerigroup Medicaid |
$3,171.37
|
| Rate for Payer: Amerigroup Medicare |
$3,173.26
|
| Rate for Payer: Cash Price |
$5,026.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,712.76
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,141.84
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,140.58
|
| Rate for Payer: Medical Associates Commercial |
$4,712.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,141.84
|
| Rate for Payer: Midlands Choice Commercial |
$4,398.58
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,188.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,712.76
|
| Rate for Payer: United Healthcare Commercial |
$5,655.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,707.37
|
|
|
trastuzumab dttb 150 mg MDV Pow
|
Facility
IP
|
$2,316.42
|
|
|
Service Code
|
CPT Q5112
|
| Hospital Charge Code |
43700531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,621.49 |
| Max. Negotiated Rate |
$2,084.78 |
| Rate for Payer: Aetna of IA Commercial |
$2,084.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,084.78
|
| Rate for Payer: Cash Price |
$1,853.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,737.32
|
| Rate for Payer: Medical Associates Commercial |
$1,737.32
|
| Rate for Payer: Midlands Choice Commercial |
$1,621.49
|
| Rate for Payer: United Healthcare Commercial |
$2,084.78
|
|
|
trastuzumab dttb 150 mg MDV Pow
|
Facility
OP
|
$2,316.42
|
|
|
Service Code
|
CPT Q5112
|
| Hospital Charge Code |
43700531
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1,157.75 |
| Max. Negotiated Rate |
$2,084.78 |
| Rate for Payer: Aetna of IA Commercial |
$2,084.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2,084.78
|
| Rate for Payer: Aetna of IA Medicare |
$1,320.36
|
| Rate for Payer: Amerigroup Medicaid |
$1,169.10
|
| Rate for Payer: Amerigroup Medicare |
$1,169.79
|
| Rate for Payer: Cash Price |
$1,853.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,737.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1,158.21
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,157.75
|
| Rate for Payer: Medical Associates Commercial |
$1,737.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$1,158.21
|
| Rate for Payer: Midlands Choice Commercial |
$1,621.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,175.58
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,737.32
|
| Rate for Payer: United Healthcare Commercial |
$2,084.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,366.69
|
|
|
trastuzumab dttb 420 mg Pow MDV
|
Facility
OP
|
$6,305.98
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43782711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,151.73 |
| Max. Negotiated Rate |
$5,675.38 |
| Rate for Payer: Aetna of IA Commercial |
$5,675.38
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5,675.38
|
| Rate for Payer: Aetna of IA Medicare |
$3,594.41
|
| Rate for Payer: Amerigroup Medicaid |
$3,182.63
|
| Rate for Payer: Amerigroup Medicare |
$3,184.52
|
| Rate for Payer: Cash Price |
$5,044.78
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4,729.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,152.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,151.73
|
| Rate for Payer: Medical Associates Commercial |
$4,729.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,152.99
|
| Rate for Payer: Midlands Choice Commercial |
$4,414.19
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,200.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$4,729.48
|
| Rate for Payer: United Healthcare Commercial |
$5,675.38
|
| Rate for Payer: United Healthcare Managed Medicare |
$3,720.53
|
|
