|
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 |
$29.03 |
| Max. Negotiated Rate |
$221.80 |
| 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 |
$37.22
|
| Rate for Payer: Amerigroup Medicare |
$29.32
|
| Rate for Payer: Cash Price |
$51.62
|
| 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 |
$29.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.85
|
| Rate for Payer: Medical Associates Commercial |
$48.39
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.03
|
| Rate for Payer: Midlands Choice Commercial |
$45.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.39
|
| Rate for Payer: United Healthcare Commercial |
$58.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.07
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
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
|
OP
|
$27.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426254
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.19 |
| 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 |
$15.62
|
| Rate for Payer: Amerigroup Medicare |
$12.31
|
| 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 |
$12.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.47
|
| Rate for Payer: Medical Associates Commercial |
$20.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.19
|
| Rate for Payer: Midlands Choice Commercial |
$18.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.01
|
| Rate for Payer: United Healthcare Commercial |
$24.37
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.98
|
|
|
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 40 mg/mL 1ml SDV Sus [VDMC]
|
Facility
|
IP
|
$33.10
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
11224388
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.17 |
| Max. Negotiated Rate |
$29.79 |
| Rate for Payer: Aetna of IA Commercial |
$29.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.79
|
| Rate for Payer: Cash Price |
$26.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.82
|
| Rate for Payer: Medical Associates Commercial |
$24.82
|
| Rate for Payer: Midlands Choice Commercial |
$23.17
|
| Rate for Payer: United Healthcare Commercial |
$29.79
|
|
|
triamcinolone acetonide 40 mg/mL 1ml SDV Sus [VDMC]
|
Facility
|
OP
|
$33.10
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
11224388
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$29.79
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.79
|
| Rate for Payer: Aetna of IA Medicare |
$18.87
|
| Rate for Payer: Amerigroup Medicaid |
$19.09
|
| Rate for Payer: Amerigroup Medicare |
$15.04
|
| Rate for Payer: Cash Price |
$26.48
|
| Rate for Payer: Cash Price |
$26.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$14.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.91
|
| Rate for Payer: Medical Associates Commercial |
$24.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$14.89
|
| Rate for Payer: Midlands Choice Commercial |
$23.17
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.18
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.13
|
| Rate for Payer: United Healthcare Commercial |
$29.79
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.53
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
triamcinolone Top 0.025% 15 gm Crm [VDMC]
|
Facility
|
OP
|
$15.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$13.57 |
| Rate for Payer: Aetna of IA Commercial |
$13.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.57
|
| Rate for Payer: Aetna of IA Medicare |
$8.60
|
| Rate for Payer: Amerigroup Medicaid |
$8.70
|
| Rate for Payer: Amerigroup Medicare |
$6.85
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.61
|
| Rate for Payer: Medical Associates Commercial |
$11.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.79
|
| Rate for Payer: Midlands Choice Commercial |
$10.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.80
|
| Rate for Payer: United Healthcare Commercial |
$13.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.90
|
|
|
triamcinolone Top 0.025% 15 gm Crm [VDMC]
|
Facility
|
IP
|
$15.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426315
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$13.57 |
| Rate for Payer: Aetna of IA Commercial |
$13.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.57
|
| Rate for Payer: Cash Price |
$12.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.31
|
| Rate for Payer: Medical Associates Commercial |
$11.31
|
| Rate for Payer: Midlands Choice Commercial |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$13.57
|
|
|
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 |
$11.05 |
| 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 |
$14.17
|
| Rate for Payer: Amerigroup Medicare |
$11.16
|
| 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 |
$11.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.03
|
| Rate for Payer: Medical Associates Commercial |
$18.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.05
|
| Rate for Payer: Midlands Choice Commercial |
$17.19
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.71
|
| 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
|
$14.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Aetna of IA Commercial |
$12.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.82
|
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.68
|
| Rate for Payer: Medical Associates Commercial |
$10.68
|
| Rate for Payer: Midlands Choice Commercial |
$9.97
|
| Rate for Payer: United Healthcare Commercial |
$12.82
|
|
|
triamcinolone Top 0.1% 15 gm Crm [VDMC]
|
Facility
|
OP
|
$14.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426510
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$12.82 |
| Rate for Payer: Aetna of IA Commercial |
$12.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.82
|
| Rate for Payer: Aetna of IA Medicare |
$8.12
|
| Rate for Payer: Amerigroup Medicaid |
$8.21
|
| Rate for Payer: Amerigroup Medicare |
$6.47
|
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.13
|
| Rate for Payer: Medical Associates Commercial |
$10.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.41
|
| Rate for Payer: Midlands Choice Commercial |
$9.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.37
|
| Rate for Payer: United Healthcare Commercial |
$12.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.40
|
|
|
triamcinolone Top 0.1% 15 gm Oint [VDMC]
|
Facility
|
OP
|
$14.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426575
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Aetna of IA Commercial |
$12.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.96
|
| Rate for Payer: Aetna of IA Medicare |
$8.21
|
| Rate for Payer: Amerigroup Medicaid |
$8.31
|
| Rate for Payer: Amerigroup Medicare |
$6.54
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.23
|
| Rate for Payer: Medical Associates Commercial |
$10.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.48
|
| Rate for Payer: Midlands Choice Commercial |
$10.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.45
|
| Rate for Payer: United Healthcare Commercial |
$12.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.50
|
|
|
triamcinolone Top 0.1% 15 gm Oint [VDMC]
|
Facility
|
IP
|
$14.40
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426575
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$12.96 |
| Rate for Payer: Aetna of IA Commercial |
$12.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$12.96
|
| Rate for Payer: Cash Price |
$11.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$10.80
|
| Rate for Payer: Medical Associates Commercial |
$10.80
|
| Rate for Payer: Midlands Choice Commercial |
$10.08
|
| Rate for Payer: United Healthcare Commercial |
$12.96
|
|
|
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 |
$8.03 |
| 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 |
$10.29
|
| Rate for Payer: Amerigroup Medicare |
$8.11
|
| 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 |
$8.03
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.19
|
| Rate for Payer: Medical Associates Commercial |
$13.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.03
|
| Rate for Payer: Midlands Choice Commercial |
$12.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.23
|
| Rate for Payer: United Healthcare Commercial |
$16.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.53
|
|
|
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 Oint [VDMC]
|
Facility
|
IP
|
$25.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426640
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$23.04 |
| Rate for Payer: Aetna of IA Commercial |
$23.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.04
|
| Rate for Payer: Cash Price |
$20.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.20
|
| Rate for Payer: Medical Associates Commercial |
$19.20
|
| Rate for Payer: Midlands Choice Commercial |
$17.92
|
| Rate for Payer: United Healthcare Commercial |
$23.04
|
|
|
triamcinolone Top 0.1% 80 gm Oint [VDMC]
|
Facility
|
OP
|
$25.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426640
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.52 |
| Max. Negotiated Rate |
$23.04 |
| Rate for Payer: Aetna of IA Commercial |
$23.04
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.04
|
| Rate for Payer: Aetna of IA Medicare |
$14.59
|
| Rate for Payer: Amerigroup Medicaid |
$14.77
|
| Rate for Payer: Amerigroup Medicare |
$11.64
|
| Rate for Payer: Cash Price |
$20.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.62
|
| Rate for Payer: Medical Associates Commercial |
$19.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.52
|
| Rate for Payer: Midlands Choice Commercial |
$17.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$13.25
|
| Rate for Payer: United Healthcare Commercial |
$23.04
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.10
|
|
|
triamcinolone topical 0.1% Pas [VDMC]
|
Facility
|
OP
|
$60.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11223022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$54.58 |
| Rate for Payer: Aetna of IA Commercial |
$54.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.58
|
| Rate for Payer: Aetna of IA Medicare |
$34.56
|
| Rate for Payer: Amerigroup Medicaid |
$34.98
|
| Rate for Payer: Amerigroup Medicare |
$27.56
|
| Rate for Payer: Cash Price |
$48.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.64
|
| Rate for Payer: Medical Associates Commercial |
$45.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.29
|
| Rate for Payer: Midlands Choice Commercial |
$42.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.15
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.38
|
| Rate for Payer: United Healthcare Commercial |
$54.58
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.78
|
|
|
triamcinolone topical 0.1% Pas [VDMC]
|
Facility
|
IP
|
$60.64
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11223022
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.45 |
| Max. Negotiated Rate |
$54.58 |
| Rate for Payer: Aetna of IA Commercial |
$54.58
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.58
|
| Rate for Payer: Cash Price |
$48.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.48
|
| Rate for Payer: Medical Associates Commercial |
$45.48
|
| Rate for Payer: Midlands Choice Commercial |
$42.45
|
| Rate for Payer: United Healthcare Commercial |
$54.58
|
|
|
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 |
$0.65 |
| Max. Negotiated Rate |
$1.29 |
| Rate for Payer: Aetna of IA Commercial |
$1.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.29
|
| Rate for Payer: Aetna of IA Medicare |
$0.82
|
| Rate for Payer: Amerigroup Medicaid |
$0.83
|
| Rate for Payer: Amerigroup Medicare |
$0.65
|
| 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 |
$0.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.82
|
| Rate for Payer: Medical Associates Commercial |
$1.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.65
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.74
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.85
|
|
|
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 |
$1.29 |
| Rate for Payer: Aetna of IA Commercial |
$1.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.29
|
| 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 |
$1.29
|
|
|
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 |
$45.00 |
| Max. Negotiated Rate |
$95.28 |
| 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 |
$57.68
|
| Rate for Payer: Amerigroup Medicare |
$45.45
|
| 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 |
$45.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.12
|
| Rate for Payer: Medical Associates Commercial |
$75.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.00
|
| Rate for Payer: Midlands Choice Commercial |
$70.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.75
|
| Rate for Payer: United Healthcare Commercial |
$90.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.00
|
| Rate for Payer: Wellmark IA HMO WHPI |
$86.50
|
| Rate for Payer: Wellmark IA PPO |
$95.28
|
|
|
TRIGEMINAL NERVE BLOCK
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
8300882
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$84.81 |
| Max. Negotiated Rate |
$252.10 |
| Rate for Payer: Amerigroup Medicaid |
$85.64
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$84.81
|
| Rate for Payer: Medical Associates Commercial |
$243.75
|
| Rate for Payer: Midlands Choice Commercial |
$227.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$85.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$243.75
|
| Rate for Payer: United Healthcare Commercial |
$158.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$214.20
|
| Rate for Payer: Wellmark IA PPO |
$252.10
|
|
