|
triamcinolone Top 0.1% 15 gm Crm [VDMC]
|
Facility
|
OP
|
$19.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.98 |
| 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: Aetna of IA Medicare |
$11.38
|
| Rate for Payer: Amerigroup Medicaid |
$10.07
|
| Rate for Payer: Amerigroup Medicare |
$10.08
|
| Rate for Payer: Cash Price |
$15.97
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$9.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9.98
|
| Rate for Payer: Medical Associates Commercial |
$14.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$9.98
|
| Rate for Payer: Midlands Choice Commercial |
$13.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.13
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$10.12
|
| Rate for Payer: Oscar Health of IA Commercial |
$14.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.97
|
| Rate for Payer: United Healthcare Commercial |
$17.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.78
|
|
|
triamcinolone Top 0.1% 15 gm Oint [VDMC]
|
Facility
|
OP
|
$15.04
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426575
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$13.54 |
| Rate for Payer: Aetna of IA Commercial |
$13.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.54
|
| Rate for Payer: Aetna of IA Medicare |
$8.57
|
| Rate for Payer: Amerigroup Medicaid |
$7.59
|
| Rate for Payer: Amerigroup Medicare |
$7.60
|
| Rate for Payer: Cash Price |
$12.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.52
|
| Rate for Payer: Medical Associates Commercial |
$11.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.52
|
| Rate for Payer: Midlands Choice Commercial |
$10.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.63
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$7.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$11.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.28
|
| Rate for Payer: United Healthcare Commercial |
$13.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.87
|
|
|
triamcinolone Top 0.1% 15 gm Oint [VDMC]
|
Facility
|
IP
|
$15.04
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426575
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$13.54 |
| Rate for Payer: Aetna of IA Commercial |
$13.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.54
|
| Rate for Payer: Cash Price |
$12.03
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.28
|
| Rate for Payer: Medical Associates Commercial |
$11.28
|
| Rate for Payer: Midlands Choice Commercial |
$10.53
|
| Rate for Payer: United Healthcare Commercial |
$13.54
|
|
|
triamcinolone Top 0.1% 80 gm Crm [VDMC]
|
Facility
|
IP
|
$17.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426445
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: Aetna of IA Commercial |
$16.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.06
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.38
|
| Rate for Payer: Medical Associates Commercial |
$13.38
|
| Rate for Payer: Midlands Choice Commercial |
$12.49
|
| Rate for Payer: United Healthcare Commercial |
$16.06
|
|
|
triamcinolone Top 0.1% 80 gm Crm [VDMC]
|
Facility
|
OP
|
$17.84
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426445
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: Aetna of IA Commercial |
$16.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.06
|
| Rate for Payer: Aetna of IA Medicare |
$10.17
|
| Rate for Payer: Amerigroup Medicaid |
$9.00
|
| Rate for Payer: Amerigroup Medicare |
$9.01
|
| Rate for Payer: Cash Price |
$14.27
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.92
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.92
|
| Rate for Payer: Medical Associates Commercial |
$13.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.92
|
| Rate for Payer: Midlands Choice Commercial |
$12.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9.05
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$9.05
|
| Rate for Payer: Oscar Health of IA Commercial |
$13.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.38
|
| Rate for Payer: United Healthcare Commercial |
$16.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.53
|
|
|
triamcinolone Top 0.1% 80 gm Oint [VDMC]
|
Facility
|
OP
|
$25.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426640
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.61 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna of IA Commercial |
$22.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.72
|
| Rate for Payer: Aetna of IA Medicare |
$14.39
|
| Rate for Payer: Amerigroup Medicaid |
$12.74
|
| Rate for Payer: Amerigroup Medicare |
$12.75
|
| Rate for Payer: Cash Price |
$20.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.61
|
| Rate for Payer: Medical Associates Commercial |
$18.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.62
|
| Rate for Payer: Midlands Choice Commercial |
$17.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12.81
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$12.80
|
| Rate for Payer: Oscar Health of IA Commercial |
$18.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.93
|
| Rate for Payer: United Healthcare Commercial |
$22.72
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.89
|
|
|
triamcinolone Top 0.1% 80 gm Oint [VDMC]
|
Facility
|
IP
|
$25.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426640
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna of IA Commercial |
$22.72
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.72
|
| Rate for Payer: Cash Price |
$20.19
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.93
|
| Rate for Payer: Medical Associates Commercial |
$18.93
|
| Rate for Payer: Midlands Choice Commercial |
$17.67
|
| Rate for Payer: United Healthcare Commercial |
$22.72
|
|
|
triamterene-hydrochlorothiazide 37.5-25 mg Cap [VDMC]
|
Facility
|
IP
|
$1.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10394181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.08
|
| Rate for Payer: Medical Associates Commercial |
$1.08
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
|
|
triamterene-hydrochlorothiazide 37.5-25 mg Cap [VDMC]
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10394181
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Aetna of IA Medicare |
$0.82
|
| Rate for Payer: Amerigroup Medicaid |
$0.73
|
| Rate for Payer: Amerigroup Medicare |
$0.73
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.72
|
| Rate for Payer: Medical Associates Commercial |
$1.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.72
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.73
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.85
|
|
|
Trichomonas vaginalis RNA (Female Only) DMCL
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
8822402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
|
|
Trichomonas vaginalis RNA (Female Only) DMCL
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
8822402
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Aetna of IA Commercial |
$90.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.00
|
| Rate for Payer: Aetna of IA Medicare |
$57.00
|
| Rate for Payer: Amerigroup Medicaid |
$50.47
|
| Rate for Payer: Amerigroup Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.98
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.75
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$50.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$75.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.00
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO |
$68.82
|
| Rate for Payer: Wellmark IA PPO |
$75.70
|
|
|
TRIGEMINAL NERVE BLOCK
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
8300882
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$45.34 |
| Max. Negotiated Rate |
$227.50 |
| Rate for Payer: Aetna of IA Medicare |
$45.34
|
| Rate for Payer: Amerigroup Medicaid |
$46.88
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$54.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.25
|
| Rate for Payer: Medical Associates Commercial |
$81.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.34
|
| Rate for Payer: Midlands Choice Commercial |
$227.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$78.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$68.01
|
|
|
TRIGEMINAL NERVE BLOCK - VDMC
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
8300885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Aetna of IA Commercial |
$586.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.80
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$489.00
|
| Rate for Payer: Medical Associates Commercial |
$489.00
|
| Rate for Payer: Midlands Choice Commercial |
$456.40
|
| Rate for Payer: United Healthcare Commercial |
$586.80
|
|
|
TRIGEMINAL NERVE BLOCK - VDMC
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
8300885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.87 |
| Max. Negotiated Rate |
$703.14 |
| Rate for Payer: Aetna of IA Commercial |
$586.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$586.80
|
| Rate for Payer: Aetna of IA Medicare |
$371.64
|
| Rate for Payer: Amerigroup Medicaid |
$329.06
|
| Rate for Payer: Amerigroup Medicare |
$329.26
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Cash Price |
$521.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$489.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$326.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$325.87
|
| Rate for Payer: Medical Associates Commercial |
$489.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$326.00
|
| Rate for Payer: Midlands Choice Commercial |
$456.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$330.89
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$330.69
|
| Rate for Payer: Oscar Health of IA Commercial |
$489.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$489.00
|
| Rate for Payer: United Healthcare Commercial |
$586.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$384.68
|
| Rate for Payer: Wellmark IA HMO |
$639.22
|
| Rate for Payer: Wellmark IA PPO |
$703.14
|
|
|
TRIGLYCERIDE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
633852
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna of IA Commercial |
$49.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.50
|
| Rate for Payer: Aetna of IA Medicare |
$31.35
|
| Rate for Payer: Amerigroup Medicaid |
$27.76
|
| Rate for Payer: Amerigroup Medicare |
$27.78
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.49
|
| Rate for Payer: Medical Associates Commercial |
$41.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.50
|
| Rate for Payer: Midlands Choice Commercial |
$38.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.91
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$27.90
|
| Rate for Payer: Oscar Health of IA Commercial |
$41.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.25
|
| Rate for Payer: United Healthcare Commercial |
$49.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.45
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
TRIGLYCERIDE
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
633852
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Aetna of IA Commercial |
$49.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.50
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.25
|
| Rate for Payer: Medical Associates Commercial |
$41.25
|
| Rate for Payer: Midlands Choice Commercial |
$38.50
|
| Rate for Payer: United Healthcare Commercial |
$49.50
|
|
|
trihexyphenidyl 2 mg Tab [VDMC]
|
Facility
|
IP
|
$1.15
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426705
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of IA Commercial |
$1.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.04
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.86
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
|
|
trihexyphenidyl 2 mg Tab [VDMC]
|
Facility
|
OP
|
$1.15
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426705
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Aetna of IA Commercial |
$1.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.04
|
| Rate for Payer: Aetna of IA Medicare |
$0.66
|
| Rate for Payer: Amerigroup Medicaid |
$0.58
|
| Rate for Payer: Amerigroup Medicare |
$0.58
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.57
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.58
|
| Rate for Payer: Midlands Choice Commercial |
$0.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.58
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$1.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.68
|
|
|
trolamine salicylate Top 10% Crm [VDMC]
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna of IA Commercial |
$12.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.60
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.50
|
| Rate for Payer: Medical Associates Commercial |
$10.50
|
| Rate for Payer: Midlands Choice Commercial |
$9.80
|
| Rate for Payer: United Healthcare Commercial |
$12.60
|
|
|
trolamine salicylate Top 10% Crm [VDMC]
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna of IA Commercial |
$12.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.60
|
| Rate for Payer: Aetna of IA Medicare |
$7.98
|
| Rate for Payer: Amerigroup Medicaid |
$7.07
|
| Rate for Payer: Amerigroup Medicare |
$7.07
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$7.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.00
|
| Rate for Payer: Medical Associates Commercial |
$10.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$7.00
|
| Rate for Payer: Midlands Choice Commercial |
$9.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.10
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$7.10
|
| Rate for Payer: Oscar Health of IA Commercial |
$10.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$10.50
|
| Rate for Payer: United Healthcare Commercial |
$12.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.26
|
|
|
tropicamide Ophth 1% Sol 15ml [VDMC]
|
Facility
|
OP
|
$36.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Aetna of IA Commercial |
$32.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.54
|
| Rate for Payer: Aetna of IA Medicare |
$20.61
|
| Rate for Payer: Amerigroup Medicaid |
$18.25
|
| Rate for Payer: Amerigroup Medicare |
$18.26
|
| Rate for Payer: Cash Price |
$28.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.07
|
| Rate for Payer: Medical Associates Commercial |
$27.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.08
|
| Rate for Payer: Midlands Choice Commercial |
$25.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.35
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$18.34
|
| Rate for Payer: Oscar Health of IA Commercial |
$27.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.12
|
| Rate for Payer: United Healthcare Commercial |
$32.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.33
|
|
|
tropicamide Ophth 1% Sol 15ml [VDMC]
|
Facility
|
IP
|
$36.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439841
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.31 |
| Max. Negotiated Rate |
$32.54 |
| Rate for Payer: Aetna of IA Commercial |
$32.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.54
|
| Rate for Payer: Cash Price |
$28.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.12
|
| Rate for Payer: Medical Associates Commercial |
$27.12
|
| Rate for Payer: Midlands Choice Commercial |
$25.31
|
| Rate for Payer: United Healthcare Commercial |
$32.54
|
|
|
TROPONIN
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
1634892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna of IA Commercial |
$145.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$145.80
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$121.50
|
| Rate for Payer: Medical Associates Commercial |
$121.50
|
| Rate for Payer: Midlands Choice Commercial |
$113.40
|
| Rate for Payer: United Healthcare Commercial |
$145.80
|
|
|
TROPONIN
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
1634892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Aetna of IA Commercial |
$145.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$145.80
|
| Rate for Payer: Aetna of IA Medicare |
$92.34
|
| Rate for Payer: Amerigroup Medicaid |
$81.76
|
| Rate for Payer: Amerigroup Medicare |
$81.81
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$121.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$81.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.97
|
| Rate for Payer: Medical Associates Commercial |
$121.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$81.00
|
| Rate for Payer: Midlands Choice Commercial |
$113.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$82.22
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$82.17
|
| Rate for Payer: Oscar Health of IA Commercial |
$121.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$121.50
|
| Rate for Payer: United Healthcare Commercial |
$145.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$95.58
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
trospium chloride 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna of IA Commercial |
$1.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.58
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.32
|
| Rate for Payer: Medical Associates Commercial |
$1.32
|
| Rate for Payer: Midlands Choice Commercial |
$1.23
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
|
