|
TIGER CANNULATED SCREW 2.4MMX20MM
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8789962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$181.69
|
| Rate for Payer: Amerigroup Medicare |
$143.17
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$141.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.93
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$141.75
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$182.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$163.01
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
TIGER CANNULATED SCREW 2.4MMX26MM
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8789964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
|
|
TIGER CANNULATED SCREW 2.4MMX26MM
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8789964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.75 |
| Max. Negotiated Rate |
$283.50 |
| Rate for Payer: Aetna of IA Commercial |
$283.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$283.50
|
| Rate for Payer: Aetna of IA Medicare |
$179.55
|
| Rate for Payer: Amerigroup Medicaid |
$181.69
|
| Rate for Payer: Amerigroup Medicare |
$143.17
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$236.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$141.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$179.93
|
| Rate for Payer: Medical Associates Commercial |
$236.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$141.75
|
| Rate for Payer: Midlands Choice Commercial |
$220.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$182.57
|
| Rate for Payer: Partners Health Alliance Commercial |
$163.01
|
| Rate for Payer: United Healthcare Commercial |
$283.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$185.85
|
|
|
TIGER CANNULATED SCREW 3.0MM X 26MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8773159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
TIGER CANNULATED SCREW 3.0MM X 26MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8773159
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
TIGER CANNULATED SCREW 4.0MMX20MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8758422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
TIGER CANNULATED SCREW 4.0MMX20MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8758422
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
TIGER CANNULATED SCREW 4.0MMx22MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8780885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
TIGER CANNULATED SCREW 4.0MMx22MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8780885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
TIGER CANNULATED SCREW 4.0MMX32MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8757682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
TIGER CANNULATED SCREW 4.0MMX32MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8757682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
TIGER CANNULATED SCREW 4.0MM X 40MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8773161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
TIGER CANNULATED SCREW 4.0MM X 40MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8773161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
TIGER CANNULATED SCREW 4.0MMX54MM
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8758426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$89.10 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Aetna of IA Medicare |
$112.86
|
| Rate for Payer: Amerigroup Medicaid |
$114.21
|
| Rate for Payer: Amerigroup Medicare |
$89.99
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$89.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$113.10
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$89.10
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$114.76
|
| Rate for Payer: Partners Health Alliance Commercial |
$102.46
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$116.82
|
|
|
TIGER CANNULATED SCREW 4.0MMX54MM
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8758426
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna of IA Commercial |
$178.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$178.20
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$148.50
|
| Rate for Payer: Medical Associates Commercial |
$148.50
|
| Rate for Payer: Midlands Choice Commercial |
$138.60
|
| Rate for Payer: United Healthcare Commercial |
$178.20
|
|
|
TIGER CANULATED SCREW 4.0MMX42MM
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8810196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna of IA Commercial |
$160.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$160.20
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$133.50
|
| Rate for Payer: Medical Associates Commercial |
$133.50
|
| Rate for Payer: Midlands Choice Commercial |
$124.60
|
| Rate for Payer: United Healthcare Commercial |
$160.20
|
|
|
TIGER CANULATED SCREW 4.0MMX42MM
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8810196
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$80.10 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Aetna of IA Commercial |
$160.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$160.20
|
| Rate for Payer: Aetna of IA Medicare |
$101.46
|
| Rate for Payer: Amerigroup Medicaid |
$102.67
|
| Rate for Payer: Amerigroup Medicare |
$80.90
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$133.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$80.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$101.67
|
| Rate for Payer: Medical Associates Commercial |
$133.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$80.10
|
| Rate for Payer: Midlands Choice Commercial |
$124.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$103.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$92.12
|
| Rate for Payer: United Healthcare Commercial |
$160.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$105.02
|
|
|
TIGERTAPE
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$218.70 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Aetna of IA Medicare |
$277.02
|
| Rate for Payer: Amerigroup Medicaid |
$280.32
|
| Rate for Payer: Amerigroup Medicare |
$220.89
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$218.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$277.60
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$218.70
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$281.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$251.50
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$286.74
|
|
|
TIGERTAPE
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8047072
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$437.40 |
| Rate for Payer: Aetna of IA Commercial |
$437.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$437.40
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$364.50
|
| Rate for Payer: Medical Associates Commercial |
$364.50
|
| Rate for Payer: Midlands Choice Commercial |
$340.20
|
| Rate for Payer: United Healthcare Commercial |
$437.40
|
|
|
tildrakizumab-asmn 100 mg/mL Syringe PFS [VDMC]
|
Facility
|
OP
|
$36,022.88
|
|
|
Service Code
|
HCPCS J3245
|
| Hospital Charge Code |
24914770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16,210.30 |
| Max. Negotiated Rate |
$32,420.59 |
| Rate for Payer: Aetna of IA Commercial |
$32,420.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32,420.59
|
| Rate for Payer: Aetna of IA Medicare |
$20,533.04
|
| Rate for Payer: Amerigroup Medicaid |
$20,778.00
|
| Rate for Payer: Amerigroup Medicare |
$16,372.40
|
| Rate for Payer: Cash Price |
$28,818.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27,017.16
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16,210.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20,576.27
|
| Rate for Payer: Medical Associates Commercial |
$27,017.16
|
| Rate for Payer: Medical Associates Managed Medicare |
$16,210.30
|
| Rate for Payer: Midlands Choice Commercial |
$25,216.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20,878.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$18,641.84
|
| Rate for Payer: United Healthcare Commercial |
$32,420.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$21,253.50
|
|
|
tildrakizumab-asmn 100 mg/mL Syringe PFS [VDMC]
|
Facility
|
IP
|
$36,022.88
|
|
|
Service Code
|
HCPCS J3245
|
| Hospital Charge Code |
24914770
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25,216.02 |
| Max. Negotiated Rate |
$32,420.59 |
| Rate for Payer: Aetna of IA Commercial |
$32,420.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32,420.59
|
| Rate for Payer: Cash Price |
$28,818.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27,017.16
|
| Rate for Payer: Medical Associates Commercial |
$27,017.16
|
| Rate for Payer: Midlands Choice Commercial |
$25,216.02
|
| Rate for Payer: United Healthcare Commercial |
$32,420.59
|
|
|
Timolol Maleate Ophth 0.5% 5 ml Sol [VDMC]
|
Facility
|
OP
|
$35.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439520
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$32.08 |
| Rate for Payer: Aetna of IA Commercial |
$32.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.08
|
| Rate for Payer: Aetna of IA Medicare |
$20.31
|
| Rate for Payer: Amerigroup Medicaid |
$20.56
|
| Rate for Payer: Amerigroup Medicare |
$16.20
|
| Rate for Payer: Cash Price |
$28.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.36
|
| Rate for Payer: Medical Associates Commercial |
$26.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.04
|
| Rate for Payer: Midlands Choice Commercial |
$24.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.44
|
| Rate for Payer: United Healthcare Commercial |
$32.08
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.03
|
|
|
Timolol Maleate Ophth 0.5% 5 ml Sol [VDMC]
|
Facility
|
IP
|
$35.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439520
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.95 |
| Max. Negotiated Rate |
$32.08 |
| Rate for Payer: Aetna of IA Commercial |
$32.08
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$32.08
|
| Rate for Payer: Cash Price |
$28.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$26.73
|
| Rate for Payer: Medical Associates Commercial |
$26.73
|
| Rate for Payer: Midlands Choice Commercial |
$24.95
|
| Rate for Payer: United Healthcare Commercial |
$32.08
|
|
|
timolol Ophth 0.25% 5ml Sol [VDMC]
|
Facility
|
IP
|
$24.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of IA Commercial |
$21.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.74
|
| Rate for Payer: Cash Price |
$19.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.12
|
| Rate for Payer: Medical Associates Commercial |
$18.12
|
| Rate for Payer: Midlands Choice Commercial |
$16.91
|
| Rate for Payer: United Healthcare Commercial |
$21.74
|
|
|
timolol Ophth 0.25% 5ml Sol [VDMC]
|
Facility
|
OP
|
$24.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10439455
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$21.74 |
| Rate for Payer: Aetna of IA Commercial |
$21.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$21.74
|
| Rate for Payer: Aetna of IA Medicare |
$13.77
|
| Rate for Payer: Amerigroup Medicaid |
$13.94
|
| Rate for Payer: Amerigroup Medicare |
$10.98
|
| Rate for Payer: Cash Price |
$19.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$10.87
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.80
|
| Rate for Payer: Medical Associates Commercial |
$18.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$10.87
|
| Rate for Payer: Midlands Choice Commercial |
$16.91
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.50
|
| Rate for Payer: United Healthcare Commercial |
$21.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.25
|
|
