|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$1,254.00
|
|
|
Service Code
|
CPT 23625
|
| Hospital Charge Code |
7982812
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$328.14 |
| Max. Negotiated Rate |
$877.80 |
| Rate for Payer: Aetna of IA Medicare |
$328.14
|
| Rate for Payer: Amerigroup Medicaid |
$339.30
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$393.77
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$334.70
|
| Rate for Payer: Medical Associates Commercial |
$590.65
|
| Rate for Payer: Medical Associates Managed Medicare |
$328.14
|
| Rate for Payer: Midlands Choice Commercial |
$877.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$567.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$492.21
|
|
|
TREAT HUMERUS FRACTURE
|
Professional
|
Both
|
$1,657.00
|
|
|
Service Code
|
CPT 24505
|
| Hospital Charge Code |
7982809
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$417.92 |
| Max. Negotiated Rate |
$1,159.90 |
| Rate for Payer: Aetna of IA Medicare |
$417.92
|
| Rate for Payer: Amerigroup Medicaid |
$432.13
|
| Rate for Payer: Cash Price |
$1,325.60
|
| Rate for Payer: Cash Price |
$1,325.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$501.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$426.28
|
| Rate for Payer: Medical Associates Commercial |
$752.26
|
| Rate for Payer: Medical Associates Managed Medicare |
$417.92
|
| Rate for Payer: Midlands Choice Commercial |
$1,159.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$723.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$626.88
|
|
|
TREAT KNEECAP DISLOCATION
|
Professional
|
Both
|
$1,194.00
|
|
|
Service Code
|
CPT 27560
|
| Hospital Charge Code |
7982794
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$317.21 |
| Max. Negotiated Rate |
$835.80 |
| Rate for Payer: Aetna of IA Medicare |
$317.21
|
| Rate for Payer: Amerigroup Medicaid |
$328.00
|
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Cash Price |
$955.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$380.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$323.55
|
| Rate for Payer: Medical Associates Commercial |
$570.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$317.21
|
| Rate for Payer: Midlands Choice Commercial |
$835.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$548.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$475.82
|
|
|
TREAT KNEECAP DISLOCATION
|
Professional
|
Both
|
$1,586.00
|
|
|
Service Code
|
CPT 27562
|
| Hospital Charge Code |
7982866
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$450.09 |
| Max. Negotiated Rate |
$1,110.20 |
| Rate for Payer: Aetna of IA Medicare |
$450.09
|
| Rate for Payer: Amerigroup Medicaid |
$465.39
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Cash Price |
$1,268.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$540.11
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$459.09
|
| Rate for Payer: Medical Associates Commercial |
$810.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$450.09
|
| Rate for Payer: Midlands Choice Commercial |
$1,110.20
|
| Rate for Payer: Oscar Health of IA Commercial |
$778.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$675.14
|
|
|
TREAT KNEE DISLOCATION
|
Professional
|
Both
|
$1,493.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
7982795
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$432.45 |
| Max. Negotiated Rate |
$1,045.10 |
| Rate for Payer: Aetna of IA Medicare |
$432.45
|
| Rate for Payer: Amerigroup Medicaid |
$447.15
|
| Rate for Payer: Cash Price |
$1,194.40
|
| Rate for Payer: Cash Price |
$1,194.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$518.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$441.10
|
| Rate for Payer: Medical Associates Commercial |
$778.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$432.45
|
| Rate for Payer: Midlands Choice Commercial |
$1,045.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$748.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$648.68
|
|
|
TREAT KNUCKLE DISLOCATION
|
Professional
|
Both
|
$1,071.00
|
|
|
Service Code
|
CPT 26700
|
| Hospital Charge Code |
7982801
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$292.54 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Aetna of IA Medicare |
$292.54
|
| Rate for Payer: Amerigroup Medicaid |
$302.49
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Cash Price |
$856.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$351.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$298.39
|
| Rate for Payer: Medical Associates Commercial |
$526.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$292.54
|
| Rate for Payer: Midlands Choice Commercial |
$749.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$506.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$438.81
|
|
|
TREATMEN CLOSED ELBOW DISLOCATION W/O ANESTH
|
Professional
|
Both
|
$1,289.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
8822635
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$317.55 |
| Max. Negotiated Rate |
$902.30 |
| Rate for Payer: Aetna of IA Medicare |
$317.55
|
| Rate for Payer: Amerigroup Medicaid |
$328.35
|
| Rate for Payer: Cash Price |
$1,031.20
|
| Rate for Payer: Cash Price |
$1,031.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$381.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$323.90
|
| Rate for Payer: Medical Associates Commercial |
$571.59
|
| Rate for Payer: Medical Associates Managed Medicare |
$317.55
|
| Rate for Payer: Midlands Choice Commercial |
$902.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$549.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$476.32
|
|
|
TREAT METACARPAL FRACTURE
|
Professional
|
Both
|
$858.00
|
|
|
Service Code
|
CPT 26600
|
| Hospital Charge Code |
7982803
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$269.60 |
| Max. Negotiated Rate |
$600.60 |
| Rate for Payer: Aetna of IA Medicare |
$269.60
|
| Rate for Payer: Amerigroup Medicaid |
$278.77
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$323.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$274.99
|
| Rate for Payer: Medical Associates Commercial |
$485.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$269.60
|
| Rate for Payer: Midlands Choice Commercial |
$600.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$466.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$404.40
|
|
|
TREAT SHOULDER DISLOCATION
|
Professional
|
Both
|
$1,251.00
|
|
|
Service Code
|
CPT 23655
|
| Hospital Charge Code |
7982810
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$375.76 |
| Max. Negotiated Rate |
$875.70 |
| Rate for Payer: Aetna of IA Medicare |
$375.76
|
| Rate for Payer: Amerigroup Medicaid |
$388.54
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$450.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$383.28
|
| Rate for Payer: Medical Associates Commercial |
$676.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$375.76
|
| Rate for Payer: Midlands Choice Commercial |
$875.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$650.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$563.64
|
|
|
TREAT SHOULDER DISLOCATION
|
Professional
|
Both
|
$1,040.00
|
|
|
Service Code
|
CPT 23650
|
| Hospital Charge Code |
7982811
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$280.17 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna of IA Medicare |
$280.17
|
| Rate for Payer: Amerigroup Medicaid |
$289.70
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Cash Price |
$832.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$336.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$285.77
|
| Rate for Payer: Medical Associates Commercial |
$504.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$280.17
|
| Rate for Payer: Midlands Choice Commercial |
$728.00
|
| Rate for Payer: Oscar Health of IA Commercial |
$484.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$420.26
|
|
|
TREAT THUMB DISLOCATION
|
Professional
|
Both
|
$1,243.00
|
|
|
Service Code
|
CPT 26641
|
| Hospital Charge Code |
7982802
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$355.28 |
| Max. Negotiated Rate |
$870.10 |
| Rate for Payer: Aetna of IA Medicare |
$355.28
|
| Rate for Payer: Amerigroup Medicaid |
$367.36
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Cash Price |
$994.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$426.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$362.39
|
| Rate for Payer: Medical Associates Commercial |
$639.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$355.28
|
| Rate for Payer: Midlands Choice Commercial |
$870.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$614.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$532.92
|
|
|
TREAT TOE DISLOCATION
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
7982791
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$86.16 |
| Max. Negotiated Rate |
$193.90 |
| Rate for Payer: Aetna of IA Medicare |
$86.16
|
| Rate for Payer: Amerigroup Medicaid |
$89.09
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$103.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$87.88
|
| Rate for Payer: Medical Associates Commercial |
$155.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$86.16
|
| Rate for Payer: Midlands Choice Commercial |
$193.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$149.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$129.24
|
|
|
Treponemal Antibodies IgG/IgM DMCL
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
8481982
|
|
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
|
|
|
Treponemal Antibodies IgG/IgM DMCL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
8481982
|
|
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
|
|
|
triamcinolone 10 mg/1mL 5ml MDV Inj Susp [VDMC]
|
Facility
|
OP
|
$64.52
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
10426185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$58.07 |
| Rate for Payer: Aetna of IA Commercial |
$58.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.07
|
| Rate for Payer: Aetna of IA Medicare |
$36.78
|
| Rate for Payer: Amerigroup Medicaid |
$32.56
|
| Rate for Payer: Amerigroup Medicare |
$32.58
|
| Rate for Payer: Cash Price |
$51.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.39
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$32.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.25
|
| Rate for Payer: Medical Associates Commercial |
$48.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$32.26
|
| Rate for Payer: Midlands Choice Commercial |
$45.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.74
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$32.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$48.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$48.39
|
| Rate for Payer: United Healthcare Commercial |
$58.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.07
|
|
|
triamcinolone 10 mg/1mL 5ml MDV Inj Susp [VDMC]
|
Facility
|
IP
|
$64.52
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
10426185
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$58.07 |
| Rate for Payer: Aetna of IA Commercial |
$58.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.07
|
| Rate for Payer: Cash Price |
$51.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$48.39
|
| Rate for Payer: Medical Associates Commercial |
$48.39
|
| Rate for Payer: Midlands Choice Commercial |
$45.16
|
| Rate for Payer: United Healthcare Commercial |
$58.07
|
|
|
triamcinolone acetonide 0.025% 80gm cream [VDMC]
|
Facility
|
IP
|
$27.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426254
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$24.37 |
| Rate for Payer: Aetna of IA Commercial |
$24.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.37
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.31
|
| Rate for Payer: Medical Associates Commercial |
$20.31
|
| Rate for Payer: Midlands Choice Commercial |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$24.37
|
|
|
triamcinolone acetonide 0.025% 80gm cream [VDMC]
|
Facility
|
OP
|
$27.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426254
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$24.37 |
| Rate for Payer: Aetna of IA Commercial |
$24.37
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.37
|
| Rate for Payer: Aetna of IA Medicare |
$15.44
|
| Rate for Payer: Amerigroup Medicaid |
$13.67
|
| Rate for Payer: Amerigroup Medicare |
$13.68
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.53
|
| Rate for Payer: Medical Associates Commercial |
$20.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.54
|
| Rate for Payer: Midlands Choice Commercial |
$18.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.74
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$13.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$20.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.31
|
| Rate for Payer: United Healthcare Commercial |
$24.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.98
|
|
|
triamcinolone acetonide 40 mg/mL 1ml SDV Sus [VDMC]
|
Facility
|
IP
|
$32.51
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
11224388
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.76 |
| Max. Negotiated Rate |
$29.26 |
| Rate for Payer: Aetna of IA Commercial |
$29.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.26
|
| Rate for Payer: Cash Price |
$26.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.38
|
| Rate for Payer: Medical Associates Commercial |
$24.38
|
| Rate for Payer: Midlands Choice Commercial |
$22.76
|
| Rate for Payer: United Healthcare Commercial |
$29.26
|
|
|
triamcinolone acetonide 40 mg/mL 1ml SDV Sus [VDMC]
|
Facility
|
OP
|
$32.51
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
11224388
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$29.26 |
| Rate for Payer: Aetna of IA Commercial |
$29.26
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.26
|
| Rate for Payer: Aetna of IA Medicare |
$18.53
|
| Rate for Payer: Amerigroup Medicaid |
$16.41
|
| Rate for Payer: Amerigroup Medicare |
$16.42
|
| Rate for Payer: Cash Price |
$26.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.26
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.25
|
| Rate for Payer: Medical Associates Commercial |
$24.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.26
|
| Rate for Payer: Midlands Choice Commercial |
$22.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.50
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$16.49
|
| Rate for Payer: Oscar Health of IA Commercial |
$24.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.38
|
| Rate for Payer: United Healthcare Commercial |
$29.26
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.18
|
|
|
triamcinolone Top 0.025% 15 gm Crm [VDMC]
|
Facility
|
OP
|
$15.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna of IA Commercial |
$14.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.22
|
| Rate for Payer: Aetna of IA Medicare |
$9.01
|
| Rate for Payer: Amerigroup Medicaid |
$7.97
|
| Rate for Payer: Amerigroup Medicare |
$7.98
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.85
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.90
|
| Rate for Payer: Medical Associates Commercial |
$11.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.90
|
| Rate for Payer: Midlands Choice Commercial |
$11.06
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.02
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$8.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$11.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.85
|
| Rate for Payer: United Healthcare Commercial |
$14.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$9.32
|
|
|
triamcinolone Top 0.025% 15 gm Crm [VDMC]
|
Facility
|
IP
|
$15.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: Aetna of IA Commercial |
$14.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$14.22
|
| Rate for Payer: Cash Price |
$12.64
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.85
|
| Rate for Payer: Medical Associates Commercial |
$11.85
|
| Rate for Payer: Midlands Choice Commercial |
$11.06
|
| Rate for Payer: United Healthcare Commercial |
$14.22
|
|
|
triamcinolone Top 0.025% 15 gm Oint [VDMC]
|
Facility
|
IP
|
$24.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna of IA Commercial |
$22.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.10
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.42
|
| Rate for Payer: Medical Associates Commercial |
$18.42
|
| Rate for Payer: Midlands Choice Commercial |
$17.19
|
| Rate for Payer: United Healthcare Commercial |
$22.10
|
|
|
triamcinolone Top 0.025% 15 gm Oint [VDMC]
|
Facility
|
OP
|
$24.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426380
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna of IA Commercial |
$22.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.10
|
| Rate for Payer: Aetna of IA Medicare |
$14.00
|
| Rate for Payer: Amerigroup Medicaid |
$12.40
|
| Rate for Payer: Amerigroup Medicare |
$12.40
|
| Rate for Payer: Cash Price |
$19.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.28
|
| Rate for Payer: Medical Associates Commercial |
$18.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.28
|
| Rate for Payer: Midlands Choice Commercial |
$17.19
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.46
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$12.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.42
|
| Rate for Payer: United Healthcare Commercial |
$22.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.49
|
|
|
triamcinolone Top 0.1% 15 gm Crm [VDMC]
|
Facility
|
IP
|
$19.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna of IA Commercial |
$17.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$17.96
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.97
|
| Rate for Payer: Medical Associates Commercial |
$14.97
|
| Rate for Payer: Midlands Choice Commercial |
$13.97
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
|
