|
TORPEDO, 4.00MMX7CM
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
8026442
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna of IA Commercial |
$163.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$163.80
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$136.50
|
| Rate for Payer: Medical Associates Commercial |
$136.50
|
| Rate for Payer: Midlands Choice Commercial |
$127.40
|
| Rate for Payer: United Healthcare Commercial |
$163.80
|
|
|
torsemide 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.47
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425568
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna of IA Commercial |
$1.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.32
|
| Rate for Payer: Aetna of IA Medicare |
$0.84
|
| Rate for Payer: Amerigroup Medicaid |
$0.74
|
| Rate for Payer: Amerigroup Medicare |
$0.74
|
| Rate for Payer: Cash Price |
$1.18
|
| 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 |
$0.74
|
| 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 |
$0.74
|
| Rate for Payer: Midlands Choice Commercial |
$1.03
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.75
|
| 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 |
$1.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.87
|
|
|
torsemide 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.47
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425568
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna of IA Commercial |
$1.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.32
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.10
|
| Rate for Payer: Medical Associates Commercial |
$1.10
|
| Rate for Payer: Midlands Choice Commercial |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$1.32
|
|
|
torsemide 5mg Tab [VDMC]
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23356518
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
|
|
torsemide 5mg Tab [VDMC]
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23356518
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Aetna of IA Medicare |
$1.02
|
| Rate for Payer: Amerigroup Medicaid |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.90
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.91
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.91
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.06
|
|
|
TOTAL PROTEIN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
8093946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
TOTAL PROTEIN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
8093946
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.29
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
TOTAL PROTEIN
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Aetna of IA Medicare |
$22.80
|
| Rate for Payer: Amerigroup Medicaid |
$20.19
|
| Rate for Payer: Amerigroup Medicare |
$20.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.99
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.30
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$20.29
|
| Rate for Payer: Oscar Health of IA Commercial |
$30.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$23.60
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
TOTAL PROTEIN
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna of IA Commercial |
$36.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$36.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$30.00
|
| Rate for Payer: Medical Associates Commercial |
$30.00
|
| Rate for Payer: Midlands Choice Commercial |
$28.00
|
| Rate for Payer: United Healthcare Commercial |
$36.00
|
|
|
T Pallidum Particle Agglutination DMCL
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
8037803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
T Pallidum Particle Agglutination DMCL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
8037803
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$47.12 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna of IA Commercial |
$102.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$102.60
|
| Rate for Payer: Aetna of IA Medicare |
$64.98
|
| Rate for Payer: Amerigroup Medicaid |
$57.54
|
| Rate for Payer: Amerigroup Medicare |
$57.57
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$85.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.98
|
| Rate for Payer: Medical Associates Commercial |
$85.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.00
|
| Rate for Payer: Midlands Choice Commercial |
$79.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.86
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$57.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$85.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$85.50
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.26
|
| Rate for Payer: Wellmark IA HMO |
$47.12
|
| Rate for Payer: Wellmark IA PPO |
$51.83
|
|
|
T-PLATE 3 HOLE 53MM OBLIQUE ANGLE
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$182.43 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Aetna of IA Commercial |
$328.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$328.50
|
| Rate for Payer: Aetna of IA Medicare |
$208.05
|
| Rate for Payer: Amerigroup Medicaid |
$184.22
|
| Rate for Payer: Amerigroup Medicare |
$184.32
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$273.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$182.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$182.43
|
| Rate for Payer: Medical Associates Commercial |
$273.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$182.50
|
| Rate for Payer: Midlands Choice Commercial |
$255.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$185.24
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$185.13
|
| Rate for Payer: Oscar Health of IA Commercial |
$273.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$273.75
|
| Rate for Payer: United Healthcare Commercial |
$328.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$215.35
|
|
|
T-PLATE 3 HOLE 53MM OBLIQUE ANGLE
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046785
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.50 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Aetna of IA Commercial |
$328.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$328.50
|
| Rate for Payer: Cash Price |
$292.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$273.75
|
| Rate for Payer: Medical Associates Commercial |
$273.75
|
| Rate for Payer: Midlands Choice Commercial |
$255.50
|
| Rate for Payer: United Healthcare Commercial |
$328.50
|
|
|
T-PLATE 3 HOLE 75MM SHAFT OBLIQUE ANGLE
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of IA Commercial |
$360.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$360.00
|
| Rate for Payer: Aetna of IA Medicare |
$228.00
|
| Rate for Payer: Amerigroup Medicaid |
$201.88
|
| Rate for Payer: Amerigroup Medicare |
$202.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$300.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$200.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$199.92
|
| Rate for Payer: Medical Associates Commercial |
$300.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$200.00
|
| Rate for Payer: Midlands Choice Commercial |
$280.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$203.00
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$202.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$300.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$300.00
|
| Rate for Payer: United Healthcare Commercial |
$360.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$236.00
|
|
|
T-PLATE 3 HOLE 75MM SHAFT OBLIQUE ANGLE
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
8046784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna of IA Commercial |
$360.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$360.00
|
| Rate for Payer: Cash Price |
$320.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$300.00
|
| Rate for Payer: Medical Associates Commercial |
$300.00
|
| Rate for Payer: Midlands Choice Commercial |
$280.00
|
| Rate for Payer: United Healthcare Commercial |
$360.00
|
|
|
trace elements with selenium 10 mcg-1 mg-0.5 mg-60 mcg-5 mg/mL IV Sol 1 mL [VDMC]
|
Facility
|
IP
|
$64.49
|
|
|
Service Code
|
NDC 00517-8201-25
|
| Hospital Charge Code |
10425639
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$45.14 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Aetna of IA Commercial |
$58.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.04
|
| Rate for Payer: Cash Price |
$51.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.37
|
| Rate for Payer: Medical Associates Commercial |
$48.37
|
| Rate for Payer: Midlands Choice Commercial |
$45.14
|
| Rate for Payer: United Healthcare Commercial |
$58.04
|
|
|
trace elements with selenium 10 mcg-1 mg-0.5 mg-60 mcg-5 mg/mL IV Sol 1 mL [VDMC]
|
Facility
|
OP
|
$64.49
|
|
|
Service Code
|
NDC 00517-8201-25
|
| Hospital Charge Code |
10425639
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.23 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Aetna of IA Commercial |
$58.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.04
|
| Rate for Payer: Aetna of IA Medicare |
$36.76
|
| Rate for Payer: Amerigroup Medicaid |
$32.55
|
| Rate for Payer: Amerigroup Medicare |
$32.57
|
| Rate for Payer: Cash Price |
$51.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.23
|
| Rate for Payer: Medical Associates Commercial |
$48.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.24
|
| Rate for Payer: Midlands Choice Commercial |
$45.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$32.71
|
| Rate for Payer: Oscar Health of IA Commercial |
$48.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.37
|
| Rate for Payer: United Healthcare Commercial |
$58.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.05
|
|
|
Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy With CC
|
Facility
|
IP
|
$25,682.80
|
|
|
Service Code
|
MS-DRG 012
|
| Hospital Charge Code |
702
|
| Min. Negotiated Rate |
$25,310.59 |
| Max. Negotiated Rate |
$25,682.80 |
| Rate for Payer: Amerigroup Medicaid |
$25,558.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25,310.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25,682.80
|
|
|
Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy With MCC
|
Facility
|
IP
|
$34,728.96
|
|
|
Service Code
|
MS-DRG 011
|
| Hospital Charge Code |
701
|
| Min. Negotiated Rate |
$34,225.64 |
| Max. Negotiated Rate |
$34,728.96 |
| Rate for Payer: Amerigroup Medicaid |
$34,561.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34,225.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34,728.96
|
|
|
Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy Without CC/MCC
|
Facility
|
IP
|
$23,280.27
|
|
|
Service Code
|
MS-DRG 013
|
| Hospital Charge Code |
703
|
| Min. Negotiated Rate |
$22,942.87 |
| Max. Negotiated Rate |
$23,280.27 |
| Rate for Payer: Amerigroup Medicaid |
$23,167.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$22,942.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$23,280.27
|
|
|
Tracheostomy With MV >96 Hours or Principal Diagnosis Except Face, Mouth and Neck Without Major O.R. Procedures
|
Facility
|
IP
|
$99,873.94
|
|
|
Service Code
|
MS-DRG 004
|
| Hospital Charge Code |
695
|
| Min. Negotiated Rate |
$98,426.49 |
| Max. Negotiated Rate |
$99,873.94 |
| Rate for Payer: Amerigroup Medicaid |
$99,391.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$98,426.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$99,873.94
|
|
|
traMADol 50 mg Tab [VDMC]
|
Facility
|
OP
|
$3.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425771
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.68 |
| 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: Aetna of IA Medicare |
$1.92
|
| Rate for Payer: Amerigroup Medicaid |
$1.70
|
| Rate for Payer: Amerigroup Medicare |
$1.70
|
| Rate for Payer: Cash Price |
$2.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.68
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.68
|
| Rate for Payer: Medical Associates Commercial |
$2.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.68
|
| Rate for Payer: Midlands Choice Commercial |
$2.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.71
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.52
|
| Rate for Payer: United Healthcare Commercial |
$3.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.98
|
|
|
traMADol 50 mg Tab [VDMC]
|
Facility
|
IP
|
$3.36
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10425771
|
|
Hospital Revenue Code
|
259
|
| 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 [VDMC]
|
Facility
|
OP
|
$32.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10425909
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$16.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.66
|
| 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 100 mg/mL 10 ml SDV INJ [VDMC]
|
Facility
|
IP
|
$32.88
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10425909
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
