|
TRIGEMINAL NERVE BLOCK - VDMC
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
8300885
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.40 |
| Max. Negotiated Rate |
$839.58 |
| 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 |
$376.07
|
| Rate for Payer: Amerigroup Medicare |
$296.33
|
| 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 |
$293.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$372.42
|
| Rate for Payer: Medical Associates Commercial |
$489.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$293.40
|
| Rate for Payer: Midlands Choice Commercial |
$456.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$377.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$337.41
|
| Rate for Payer: United Healthcare Commercial |
$586.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$384.68
|
| Rate for Payer: Wellmark IA HMO WHPI |
$762.18
|
| Rate for Payer: Wellmark IA PPO |
$839.58
|
|
|
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
|
|
|
TRIGLYCERIDE
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
633852
|
|
Hospital Revenue Code
|
301
|
| 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 |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
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
|
OP
|
$1.15
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426705
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna of IA Commercial |
$1.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.03
|
| Rate for Payer: Aetna of IA Medicare |
$0.65
|
| Rate for Payer: Amerigroup Medicaid |
$0.66
|
| Rate for Payer: Amerigroup Medicare |
$0.52
|
| 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 |
$0.52
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
| Rate for Payer: Medical Associates Commercial |
$0.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.52
|
| Rate for Payer: Midlands Choice Commercial |
$0.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.59
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.68
|
|
|
trihexyphenidyl 2 mg Tab [VDMC]
|
Facility
|
IP
|
$1.15
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426705
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna of IA Commercial |
$1.03
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.03
|
| 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 |
$0.80
|
| Rate for Payer: United Healthcare Commercial |
$1.03
|
|
|
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 |
$6.30 |
| 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 |
$8.07
|
| Rate for Payer: Amerigroup Medicare |
$6.36
|
| 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 |
$6.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.99
|
| Rate for Payer: Medical Associates Commercial |
$10.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.30
|
| Rate for Payer: Midlands Choice Commercial |
$9.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.24
|
| Rate for Payer: United Healthcare Commercial |
$12.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.26
|
|
|
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
|
|
|
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
|
|
|
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 |
$16.27 |
| 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 |
$20.86
|
| Rate for Payer: Amerigroup Medicare |
$16.43
|
| 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 |
$16.27
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$20.65
|
| Rate for Payer: Medical Associates Commercial |
$27.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.27
|
| Rate for Payer: Midlands Choice Commercial |
$25.31
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$18.71
|
| Rate for Payer: United Healthcare Commercial |
$32.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.33
|
|
|
TROPONIN
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
1634892
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.68 |
| 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 |
$93.44
|
| Rate for Payer: Amerigroup Medicare |
$73.63
|
| 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 |
$72.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$92.53
|
| Rate for Payer: Medical Associates Commercial |
$121.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.90
|
| Rate for Payer: Midlands Choice Commercial |
$113.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$93.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.84
|
| Rate for Payer: United Healthcare Commercial |
$145.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$95.58
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
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
|
|
|
trospium chloride 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10426774
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna of IA Commercial |
$1.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.59
|
| Rate for Payer: Aetna of IA Medicare |
$1.01
|
| Rate for Payer: Amerigroup Medicaid |
$1.02
|
| Rate for Payer: Amerigroup Medicare |
$0.80
|
| Rate for Payer: Cash Price |
$1.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.32
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.79
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.01
|
| Rate for Payer: Medical Associates Commercial |
$1.32
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.79
|
| Rate for Payer: Midlands Choice Commercial |
$1.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.02
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.91
|
| Rate for Payer: United Healthcare Commercial |
$1.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.04
|
|
|
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 |
$1.24 |
| Max. Negotiated Rate |
$1.59 |
| Rate for Payer: Aetna of IA Commercial |
$1.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.59
|
| 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 |
$1.24
|
| Rate for Payer: United Healthcare Commercial |
$1.59
|
|
|
trypan blue Ophth 0.06% Sol [VDMC]
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
NDC 68803-0612-10
|
| Hospital Charge Code |
10439906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$138.15 |
| Max. Negotiated Rate |
$276.30 |
| Rate for Payer: Aetna of IA Commercial |
$276.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$276.30
|
| Rate for Payer: Aetna of IA Medicare |
$174.99
|
| Rate for Payer: Amerigroup Medicaid |
$177.08
|
| Rate for Payer: Amerigroup Medicare |
$139.53
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$230.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$138.15
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$175.36
|
| Rate for Payer: Medical Associates Commercial |
$230.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$138.15
|
| Rate for Payer: Midlands Choice Commercial |
$214.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$177.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.87
|
| Rate for Payer: United Healthcare Commercial |
$276.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$181.13
|
|
|
trypan blue Ophth 0.06% Sol [VDMC]
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
NDC 68803-0612-10
|
| Hospital Charge Code |
10439906
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$214.90 |
| Max. Negotiated Rate |
$276.30 |
| Rate for Payer: Aetna of IA Commercial |
$276.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$276.30
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$230.25
|
| Rate for Payer: Medical Associates Commercial |
$230.25
|
| Rate for Payer: Midlands Choice Commercial |
$214.90
|
| Rate for Payer: United Healthcare Commercial |
$276.30
|
|
|
Tryptase DMCL
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
8037820
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$86.10 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
|
|
Tryptase DMCL
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
8037820
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$55.35 |
| Max. Negotiated Rate |
$110.70 |
| Rate for Payer: Aetna of IA Commercial |
$110.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.70
|
| Rate for Payer: Aetna of IA Medicare |
$70.11
|
| Rate for Payer: Amerigroup Medicaid |
$70.95
|
| Rate for Payer: Amerigroup Medicare |
$55.90
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$70.26
|
| Rate for Payer: Medical Associates Commercial |
$92.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.35
|
| Rate for Payer: Midlands Choice Commercial |
$86.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$71.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$63.65
|
| Rate for Payer: United Healthcare Commercial |
$110.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.57
|
| Rate for Payer: Wellmark IA HMO WHPI |
$61.68
|
| Rate for Payer: Wellmark IA PPO |
$67.95
|
|
|
TSH
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$95.90 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of IA Commercial |
$123.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$123.30
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.75
|
| Rate for Payer: Medical Associates Commercial |
$102.75
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: United Healthcare Commercial |
$123.30
|
|
|
TSH
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.63 |
| Max. Negotiated Rate |
$123.30 |
| Rate for Payer: Aetna of IA Commercial |
$123.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$123.30
|
| Rate for Payer: Aetna of IA Medicare |
$78.09
|
| Rate for Payer: Amerigroup Medicaid |
$79.02
|
| Rate for Payer: Amerigroup Medicare |
$62.27
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$102.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.25
|
| Rate for Payer: Medical Associates Commercial |
$102.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.65
|
| Rate for Payer: Midlands Choice Commercial |
$95.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$70.90
|
| Rate for Payer: United Healthcare Commercial |
$123.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$80.83
|
| Rate for Payer: Wellmark IA HMO WHPI |
$49.63
|
| Rate for Payer: Wellmark IA PPO |
$54.67
|
|
|
tuberculin purified protein derivative 5 TU/0.1 mL ID MDV Sol [VDMC]
|
Facility
|
IP
|
$60.51
|
|
|
Service Code
|
NDC 49281-0752-21
|
| Hospital Charge Code |
10426843
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$42.36 |
| Max. Negotiated Rate |
$54.46 |
| Rate for Payer: Aetna of IA Commercial |
$54.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.46
|
| Rate for Payer: Cash Price |
$48.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.38
|
| Rate for Payer: Medical Associates Commercial |
$45.38
|
| Rate for Payer: Midlands Choice Commercial |
$42.36
|
| Rate for Payer: United Healthcare Commercial |
$54.46
|
|
|
tuberculin purified protein derivative 5 TU/0.1 mL ID MDV Sol [VDMC]
|
Facility
|
OP
|
$60.51
|
|
|
Service Code
|
NDC 49281-0752-21
|
| Hospital Charge Code |
10426843
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.23 |
| Max. Negotiated Rate |
$54.46 |
| Rate for Payer: Aetna of IA Commercial |
$54.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$54.46
|
| Rate for Payer: Aetna of IA Medicare |
$34.49
|
| Rate for Payer: Amerigroup Medicaid |
$34.90
|
| Rate for Payer: Amerigroup Medicare |
$27.50
|
| Rate for Payer: Cash Price |
$48.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$45.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.56
|
| Rate for Payer: Medical Associates Commercial |
$45.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.23
|
| Rate for Payer: Midlands Choice Commercial |
$42.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$35.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$31.31
|
| Rate for Payer: United Healthcare Commercial |
$54.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.70
|
|
|
TUBE THORACOSTOMY, INCLUDES CONNECTION TO DRAINAGE SYSTEM (EG, WATER SEAL), WHEN PERFORMED, OPEN (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$1,640.88
|
|
|
Service Code
|
CPT 32551
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$1,489.61 |
| Max. Negotiated Rate |
$1,640.88 |
| Rate for Payer: Wellmark IA HMO WHPI |
$1,489.61
|
| Rate for Payer: Wellmark IA PPO |
$1,640.88
|
|
|
ULTRASOUND PER 15 MIN
|
Facility
|
IP
|
$99.00
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
1373448
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
|
|
ULTRASOUND PER 15 MIN
|
Facility
|
OP
|
$99.00
|
|
|
Service Code
|
CPT 97035 GO
|
| Hospital Charge Code |
1373448
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna of IA Commercial |
$89.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$89.10
|
| Rate for Payer: Aetna of IA Medicare |
$56.43
|
| Rate for Payer: Amerigroup Medicaid |
$57.10
|
| Rate for Payer: Amerigroup Medicare |
$45.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$44.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$56.55
|
| Rate for Payer: Medical Associates Commercial |
$74.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$44.55
|
| Rate for Payer: Midlands Choice Commercial |
$69.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$57.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$51.23
|
| Rate for Payer: United Healthcare Commercial |
$89.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$73.74
|
| Rate for Payer: Wellmark IA PPO |
$81.22
|
|
