|
THP methylPREDNISolone 4 mg Tab[VDMC]
|
Facility
|
OP
|
$76.28
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
11698580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.33 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$68.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.65
|
| Rate for Payer: Aetna of IA Medicare |
$43.48
|
| Rate for Payer: Amerigroup Medicaid |
$44.00
|
| Rate for Payer: Amerigroup Medicare |
$34.67
|
| Rate for Payer: Cash Price |
$61.02
|
| Rate for Payer: Cash Price |
$61.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.21
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.33
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.57
|
| Rate for Payer: Medical Associates Commercial |
$57.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.33
|
| Rate for Payer: Midlands Choice Commercial |
$53.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.48
|
| Rate for Payer: United Healthcare Commercial |
$68.65
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.01
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
THP methylPREDNISolone 4 mg Tab[VDMC]
|
Facility
|
IP
|
$76.28
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
11698580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.40 |
| Max. Negotiated Rate |
$68.65 |
| Rate for Payer: Aetna of IA Commercial |
$68.65
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.65
|
| Rate for Payer: Cash Price |
$61.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.21
|
| Rate for Payer: Medical Associates Commercial |
$57.21
|
| Rate for Payer: Midlands Choice Commercial |
$53.40
|
| Rate for Payer: United Healthcare Commercial |
$68.65
|
|
|
THP nitrofurantoin 50 mg cap [VDMC]
|
Facility
|
IP
|
$22.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10729893
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of IA Commercial |
$20.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.66
|
| Rate for Payer: Cash Price |
$18.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.22
|
| Rate for Payer: Medical Associates Commercial |
$17.22
|
| Rate for Payer: Midlands Choice Commercial |
$16.07
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
|
|
THP nitrofurantoin 50 mg cap [VDMC]
|
Facility
|
OP
|
$22.96
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10729893
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$20.66 |
| Rate for Payer: Aetna of IA Commercial |
$20.66
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.66
|
| Rate for Payer: Aetna of IA Medicare |
$13.09
|
| Rate for Payer: Amerigroup Medicaid |
$13.24
|
| Rate for Payer: Amerigroup Medicare |
$10.44
|
| Rate for Payer: Cash Price |
$18.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.22
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.33
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.11
|
| Rate for Payer: Medical Associates Commercial |
$17.22
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.33
|
| Rate for Payer: Midlands Choice Commercial |
$16.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$11.88
|
| Rate for Payer: United Healthcare Commercial |
$20.66
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.55
|
|
|
THP ondansetron 4 mg tab-DIS 5 Tablets [VDMC]
|
Facility
|
OP
|
$13.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10730029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$12.42 |
| Rate for Payer: Aetna of IA Commercial |
$12.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.42
|
| Rate for Payer: Aetna of IA Medicare |
$7.87
|
| Rate for Payer: Amerigroup Medicaid |
$7.96
|
| Rate for Payer: Amerigroup Medicare |
$6.27
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.35
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.21
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.88
|
| Rate for Payer: Medical Associates Commercial |
$10.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.21
|
| Rate for Payer: Midlands Choice Commercial |
$9.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.14
|
| Rate for Payer: United Healthcare Commercial |
$12.42
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.14
|
|
|
THP ondansetron 4 mg tab-DIS 5 Tablets [VDMC]
|
Facility
|
IP
|
$13.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10730029
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$12.42 |
| Rate for Payer: Aetna of IA Commercial |
$12.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.42
|
| Rate for Payer: Cash Price |
$11.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.35
|
| Rate for Payer: Medical Associates Commercial |
$10.35
|
| Rate for Payer: Midlands Choice Commercial |
$9.66
|
| Rate for Payer: United Healthcare Commercial |
$12.42
|
|
|
THP oxycodone/APAP 5 mg/325 mg 5 tablets [VDMC]
|
Facility
|
OP
|
$14.75
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10730096
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$13.27 |
| Rate for Payer: Aetna of IA Commercial |
$13.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.27
|
| Rate for Payer: Aetna of IA Medicare |
$8.41
|
| Rate for Payer: Amerigroup Medicaid |
$8.51
|
| Rate for Payer: Amerigroup Medicare |
$6.70
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.42
|
| Rate for Payer: Medical Associates Commercial |
$11.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.64
|
| Rate for Payer: Midlands Choice Commercial |
$10.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.63
|
| Rate for Payer: United Healthcare Commercial |
$13.27
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.70
|
|
|
THP oxycodone/APAP 5 mg/325 mg 5 tablets [VDMC]
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10730096
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$13.27 |
| Rate for Payer: Aetna of IA Commercial |
$13.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.27
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.06
|
| Rate for Payer: Medical Associates Commercial |
$11.06
|
| Rate for Payer: Midlands Choice Commercial |
$10.32
|
| Rate for Payer: United Healthcare Commercial |
$13.27
|
|
|
THP phenazopyridine 200 mg 6 tabs [VDMC]
|
Facility
|
IP
|
$18.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10730193
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna of IA Commercial |
$16.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.56
|
| Rate for Payer: Cash Price |
$14.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.80
|
| Rate for Payer: Medical Associates Commercial |
$13.80
|
| Rate for Payer: Midlands Choice Commercial |
$12.88
|
| Rate for Payer: United Healthcare Commercial |
$16.56
|
|
|
THP phenazopyridine 200 mg 6 tabs [VDMC]
|
Facility
|
OP
|
$18.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10730193
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.28 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna of IA Commercial |
$16.56
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.56
|
| Rate for Payer: Aetna of IA Medicare |
$10.49
|
| Rate for Payer: Amerigroup Medicaid |
$10.61
|
| Rate for Payer: Amerigroup Medicare |
$8.36
|
| Rate for Payer: Cash Price |
$14.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.28
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.51
|
| Rate for Payer: Medical Associates Commercial |
$13.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.28
|
| Rate for Payer: Midlands Choice Commercial |
$12.88
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.52
|
| Rate for Payer: United Healthcare Commercial |
$16.56
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.86
|
|
|
THP promethazine 25mg tabs [VDMC]
|
Facility
|
IP
|
$14.71
|
|
|
Service Code
|
NDC 99998-1830-01
|
| Hospital Charge Code |
10733780
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.30 |
| Max. Negotiated Rate |
$13.24 |
| Rate for Payer: Aetna of IA Commercial |
$13.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.24
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.04
|
| Rate for Payer: Medical Associates Commercial |
$11.04
|
| Rate for Payer: Midlands Choice Commercial |
$10.30
|
| Rate for Payer: United Healthcare Commercial |
$13.24
|
|
|
THP promethazine 25mg tabs [VDMC]
|
Facility
|
OP
|
$14.71
|
|
|
Service Code
|
NDC 99998-1830-01
|
| Hospital Charge Code |
10733780
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$13.24 |
| Rate for Payer: Aetna of IA Commercial |
$13.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.24
|
| Rate for Payer: Aetna of IA Medicare |
$8.39
|
| Rate for Payer: Amerigroup Medicaid |
$8.49
|
| Rate for Payer: Amerigroup Medicare |
$6.69
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.40
|
| Rate for Payer: Medical Associates Commercial |
$11.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.62
|
| Rate for Payer: Midlands Choice Commercial |
$10.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.61
|
| Rate for Payer: United Healthcare Commercial |
$13.24
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.68
|
|
|
THP promethazine/codeine 6.25/10mg/5mL syrup [VDMC]
|
Facility
|
OP
|
$11.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10734004
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Aetna of IA Commercial |
$10.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.05
|
| Rate for Payer: Aetna of IA Medicare |
$6.37
|
| Rate for Payer: Amerigroup Medicaid |
$6.44
|
| Rate for Payer: Amerigroup Medicare |
$5.08
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.38
|
| Rate for Payer: Medical Associates Commercial |
$8.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.03
|
| Rate for Payer: Midlands Choice Commercial |
$7.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.78
|
| Rate for Payer: United Healthcare Commercial |
$10.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.59
|
|
|
THP promethazine/codeine 6.25/10mg/5mL syrup [VDMC]
|
Facility
|
IP
|
$11.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10734004
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$10.05 |
| Rate for Payer: Aetna of IA Commercial |
$10.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.05
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.38
|
| Rate for Payer: Medical Associates Commercial |
$8.38
|
| Rate for Payer: Midlands Choice Commercial |
$7.82
|
| Rate for Payer: United Healthcare Commercial |
$10.05
|
|
|
THP sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Sus 30 mL [VDMC]
|
Facility
|
OP
|
$32.73
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11422706
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Aetna of IA Commercial |
$29.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.45
|
| Rate for Payer: Aetna of IA Medicare |
$18.65
|
| Rate for Payer: Amerigroup Medicaid |
$18.88
|
| Rate for Payer: Amerigroup Medicare |
$14.87
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.73
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.69
|
| Rate for Payer: Medical Associates Commercial |
$24.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.73
|
| Rate for Payer: Midlands Choice Commercial |
$22.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$16.94
|
| Rate for Payer: United Healthcare Commercial |
$29.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.31
|
|
|
THP sulfamethoxazole-trimethoprim 200 mg-40 mg/5 mL Sus 30 mL [VDMC]
|
Facility
|
IP
|
$32.73
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11422706
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Aetna of IA Commercial |
$29.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.45
|
| Rate for Payer: Cash Price |
$26.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.55
|
| Rate for Payer: Medical Associates Commercial |
$24.55
|
| Rate for Payer: Midlands Choice Commercial |
$22.91
|
| Rate for Payer: United Healthcare Commercial |
$29.45
|
|
|
THP sulfamethoxazole-trimethoprim DS 800 mg/160 mg 6 Tablet[VDMC]
|
Facility
|
OP
|
$13.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10735326
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Aetna of IA Commercial |
$12.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.24
|
| Rate for Payer: Aetna of IA Medicare |
$7.75
|
| Rate for Payer: Amerigroup Medicaid |
$7.84
|
| Rate for Payer: Amerigroup Medicare |
$6.18
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.77
|
| Rate for Payer: Medical Associates Commercial |
$10.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.12
|
| Rate for Payer: Midlands Choice Commercial |
$9.52
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.04
|
| Rate for Payer: United Healthcare Commercial |
$12.24
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.02
|
|
|
THP sulfamethoxazole-trimethoprim DS 800 mg/160 mg 6 Tablet[VDMC]
|
Facility
|
IP
|
$13.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10735326
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$12.24 |
| Rate for Payer: Aetna of IA Commercial |
$12.24
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.24
|
| Rate for Payer: Cash Price |
$10.88
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.20
|
| Rate for Payer: Medical Associates Commercial |
$10.20
|
| Rate for Payer: Midlands Choice Commercial |
$9.52
|
| Rate for Payer: United Healthcare Commercial |
$12.24
|
|
|
THP Tizanidine 4mg 5 tablets [VDMC]
|
Facility
|
IP
|
$11.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
28941700
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna of IA Commercial |
$10.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.00
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.34
|
| Rate for Payer: Medical Associates Commercial |
$8.34
|
| Rate for Payer: Midlands Choice Commercial |
$7.78
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
|
|
THP Tizanidine 4mg 5 tablets [VDMC]
|
Facility
|
OP
|
$11.12
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
28941700
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$10.00 |
| Rate for Payer: Aetna of IA Commercial |
$10.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.00
|
| Rate for Payer: Aetna of IA Medicare |
$6.34
|
| Rate for Payer: Amerigroup Medicaid |
$6.41
|
| Rate for Payer: Amerigroup Medicare |
$5.05
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.35
|
| Rate for Payer: Medical Associates Commercial |
$8.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.00
|
| Rate for Payer: Midlands Choice Commercial |
$7.78
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.75
|
| Rate for Payer: United Healthcare Commercial |
$10.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.56
|
|
|
THP tramadol 50 mg tab [VDMC]
|
Facility
|
OP
|
$11.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10735637
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Aetna of IA Commercial |
$9.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.97
|
| Rate for Payer: Aetna of IA Medicare |
$6.31
|
| Rate for Payer: Amerigroup Medicaid |
$6.39
|
| Rate for Payer: Amerigroup Medicare |
$5.03
|
| Rate for Payer: Cash Price |
$8.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.33
|
| Rate for Payer: Medical Associates Commercial |
$8.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.99
|
| Rate for Payer: Midlands Choice Commercial |
$7.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.73
|
| Rate for Payer: United Healthcare Commercial |
$9.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.54
|
|
|
THP tramadol 50 mg tab [VDMC]
|
Facility
|
IP
|
$11.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10735637
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.75 |
| Max. Negotiated Rate |
$9.97 |
| Rate for Payer: Aetna of IA Commercial |
$9.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.97
|
| Rate for Payer: Cash Price |
$8.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$8.31
|
| Rate for Payer: Medical Associates Commercial |
$8.31
|
| Rate for Payer: Midlands Choice Commercial |
$7.75
|
| Rate for Payer: United Healthcare Commercial |
$9.97
|
|
|
THROAT CULTURE
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633905
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
|
|
THROAT CULTURE
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633905
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.03 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna of IA Commercial |
$94.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$94.50
|
| Rate for Payer: Aetna of IA Medicare |
$59.85
|
| Rate for Payer: Amerigroup Medicaid |
$60.56
|
| Rate for Payer: Amerigroup Medicare |
$47.72
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$78.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.98
|
| Rate for Payer: Medical Associates Commercial |
$78.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.25
|
| Rate for Payer: Midlands Choice Commercial |
$73.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$60.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$54.34
|
| Rate for Payer: United Healthcare Commercial |
$94.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$61.95
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
THROMBIN TIME
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
8093945
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$24.75 |
| 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 |
$31.72
|
| Rate for Payer: Amerigroup Medicare |
$25.00
|
| 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 |
$24.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.42
|
| Rate for Payer: Medical Associates Commercial |
$41.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$24.75
|
| Rate for Payer: Midlands Choice Commercial |
$38.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$31.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.46
|
| Rate for Payer: United Healthcare Commercial |
$49.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$29.07
|
| Rate for Payer: Wellmark IA PPO |
$32.02
|
|
