|
Dextrose 5% with 0.9% NaCl intravenous solution 500 mL [VDMC]
|
Facility
|
OP
|
$65.50
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
11220493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$58.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.95
|
| Rate for Payer: Aetna of IA Medicare |
$37.34
|
| Rate for Payer: Amerigroup Medicaid |
$37.78
|
| Rate for Payer: Amerigroup Medicare |
$29.77
|
| Rate for Payer: Cash Price |
$52.40
|
| Rate for Payer: Cash Price |
$52.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.12
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.48
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$37.41
|
| Rate for Payer: Medical Associates Commercial |
$49.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.48
|
| Rate for Payer: Midlands Choice Commercial |
$45.85
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$33.90
|
| Rate for Payer: United Healthcare Commercial |
$58.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.64
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
Dextrose 5% with NS and KCl 40 mEq/l IV Sol 1000 mL [VDMC]
|
Facility
|
OP
|
$67.64
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
10441104
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$30.44 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$60.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.88
|
| Rate for Payer: Aetna of IA Medicare |
$38.55
|
| Rate for Payer: Amerigroup Medicaid |
$39.01
|
| Rate for Payer: Amerigroup Medicare |
$30.74
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.73
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$30.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.64
|
| Rate for Payer: Medical Associates Commercial |
$50.73
|
| Rate for Payer: Medical Associates Managed Medicare |
$30.44
|
| Rate for Payer: Midlands Choice Commercial |
$47.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$39.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$35.00
|
| Rate for Payer: United Healthcare Commercial |
$60.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.91
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
Dextrose 5% with NS and KCl 40 mEq/l IV Sol 1000 mL [VDMC]
|
Facility
|
IP
|
$67.64
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
10441104
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.35 |
| Max. Negotiated Rate |
$60.88 |
| Rate for Payer: Aetna of IA Commercial |
$60.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$60.88
|
| Rate for Payer: Cash Price |
$54.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$50.73
|
| Rate for Payer: Medical Associates Commercial |
$50.73
|
| Rate for Payer: Midlands Choice Commercial |
$47.35
|
| Rate for Payer: United Healthcare Commercial |
$60.88
|
|
|
dextrose emergency syringe 50% IV Sol 50 mL [VDMC]
|
Facility
|
OP
|
$79.27
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
10434776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$71.34 |
| Rate for Payer: Aetna of IA Commercial |
$71.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$71.34
|
| Rate for Payer: Aetna of IA Medicare |
$45.19
|
| Rate for Payer: Amerigroup Medicaid |
$45.72
|
| Rate for Payer: Amerigroup Medicare |
$36.03
|
| Rate for Payer: Cash Price |
$63.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.45
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.67
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$45.28
|
| Rate for Payer: Medical Associates Commercial |
$59.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.67
|
| Rate for Payer: Midlands Choice Commercial |
$55.49
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$45.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.02
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$46.77
|
|
|
dextrose emergency syringe 50% IV Sol 50 mL [VDMC]
|
Facility
|
IP
|
$79.27
|
|
|
Service Code
|
HCPCS J7799
|
| Hospital Charge Code |
10434776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$71.34 |
| Rate for Payer: Aetna of IA Commercial |
$71.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$71.34
|
| Rate for Payer: Cash Price |
$63.42
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$59.45
|
| Rate for Payer: Medical Associates Commercial |
$59.45
|
| Rate for Payer: Midlands Choice Commercial |
$55.49
|
| Rate for Payer: United Healthcare Commercial |
$71.34
|
|
|
DIAB ED GROUP T19
|
Facility
|
OP
|
$1,022.00
|
|
|
Service Code
|
HCPCS S9455
|
| Hospital Charge Code |
8059033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of IA Commercial |
$919.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$919.80
|
| Rate for Payer: Aetna of IA Medicare |
$582.54
|
| Rate for Payer: Amerigroup Medicaid |
$589.49
|
| Rate for Payer: Amerigroup Medicare |
$464.50
|
| Rate for Payer: Cash Price |
$817.60
|
| Rate for Payer: Cash Price |
$817.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$766.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$459.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$583.77
|
| Rate for Payer: Medical Associates Commercial |
$766.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$459.90
|
| Rate for Payer: Midlands Choice Commercial |
$715.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$592.35
|
| Rate for Payer: Partners Health Alliance Commercial |
$528.88
|
| Rate for Payer: United Healthcare Commercial |
$919.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$602.98
|
| Rate for Payer: Wellmark IA HMO WHPI |
$102.10
|
| Rate for Payer: Wellmark IA PPO |
$112.46
|
|
|
DIAB ED GROUP T19
|
Facility
|
IP
|
$1,022.00
|
|
|
Service Code
|
HCPCS S9455
|
| Hospital Charge Code |
8059033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$715.40 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of IA Commercial |
$919.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$919.80
|
| Rate for Payer: Cash Price |
$817.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$766.50
|
| Rate for Payer: Medical Associates Commercial |
$766.50
|
| Rate for Payer: Midlands Choice Commercial |
$715.40
|
| Rate for Payer: United Healthcare Commercial |
$919.80
|
|
|
DIABETES ED-GROUP EA 30 MINUTE
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
5616793
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Aetna of IA Commercial |
$81.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.90
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$68.25
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
|
|
DIABETES ED-GROUP EA 30 MINUTE
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
HCPCS G0109
|
| Hospital Charge Code |
5616793
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$112.46 |
| Rate for Payer: Aetna of IA Commercial |
$81.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$81.90
|
| Rate for Payer: Aetna of IA Medicare |
$51.87
|
| Rate for Payer: Amerigroup Medicaid |
$52.49
|
| Rate for Payer: Amerigroup Medicare |
$41.36
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$68.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$40.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$51.98
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.95
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$52.74
|
| Rate for Payer: Partners Health Alliance Commercial |
$47.09
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.69
|
| Rate for Payer: Wellmark IA HMO WHPI |
$102.10
|
| Rate for Payer: Wellmark IA PPO |
$112.46
|
|
|
DIABETES ED INDIV EA 30 MINS
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
5616792
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$66.60 |
| Max. Negotiated Rate |
$224.93 |
| Rate for Payer: Aetna of IA Commercial |
$133.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$133.20
|
| Rate for Payer: Aetna of IA Medicare |
$84.36
|
| Rate for Payer: Amerigroup Medicaid |
$85.37
|
| Rate for Payer: Amerigroup Medicare |
$67.27
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$66.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$84.54
|
| Rate for Payer: Medical Associates Commercial |
$111.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$66.60
|
| Rate for Payer: Midlands Choice Commercial |
$103.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$85.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$76.59
|
| Rate for Payer: United Healthcare Commercial |
$133.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.32
|
| Rate for Payer: Wellmark IA HMO WHPI |
$204.19
|
| Rate for Payer: Wellmark IA PPO |
$224.93
|
|
|
DIABETES ED INDIV EA 30 MINS
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS G0108
|
| Hospital Charge Code |
5616792
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna of IA Commercial |
$133.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$133.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$111.00
|
| Rate for Payer: Medical Associates Commercial |
$111.00
|
| Rate for Payer: Midlands Choice Commercial |
$103.60
|
| Rate for Payer: United Healthcare Commercial |
$133.20
|
|
|
DIABETES ED IND PROGRAM
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS S9455
|
| Hospital Charge Code |
8059032
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$1,129.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,129.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,129.50
|
| Rate for Payer: Aetna of IA Medicare |
$715.35
|
| Rate for Payer: Amerigroup Medicaid |
$723.88
|
| Rate for Payer: Amerigroup Medicare |
$570.40
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$941.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$564.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$716.86
|
| Rate for Payer: Medical Associates Commercial |
$941.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$564.75
|
| Rate for Payer: Midlands Choice Commercial |
$878.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$727.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$649.46
|
| Rate for Payer: United Healthcare Commercial |
$1,129.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$740.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$102.10
|
| Rate for Payer: Wellmark IA PPO |
$112.46
|
|
|
DIABETES ED IND PROGRAM
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS S9455
|
| Hospital Charge Code |
8059032
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$878.50 |
| Max. Negotiated Rate |
$1,129.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,129.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,129.50
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$941.25
|
| Rate for Payer: Medical Associates Commercial |
$941.25
|
| Rate for Payer: Midlands Choice Commercial |
$878.50
|
| Rate for Payer: United Healthcare Commercial |
$1,129.50
|
|
|
DIABETES ED IND PROGRAM T19
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
HCPCS S9455
|
| Hospital Charge Code |
7803727
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$878.50 |
| Max. Negotiated Rate |
$1,129.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,129.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,129.50
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$941.25
|
| Rate for Payer: Medical Associates Commercial |
$941.25
|
| Rate for Payer: Midlands Choice Commercial |
$878.50
|
| Rate for Payer: United Healthcare Commercial |
$1,129.50
|
|
|
DIABETES ED IND PROGRAM T19
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
HCPCS S9455
|
| Hospital Charge Code |
7803727
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$102.10 |
| Max. Negotiated Rate |
$1,129.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,129.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,129.50
|
| Rate for Payer: Aetna of IA Medicare |
$715.35
|
| Rate for Payer: Amerigroup Medicaid |
$723.88
|
| Rate for Payer: Amerigroup Medicare |
$570.40
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Cash Price |
$1,004.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$941.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$564.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$716.86
|
| Rate for Payer: Medical Associates Commercial |
$941.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$564.75
|
| Rate for Payer: Midlands Choice Commercial |
$878.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$727.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$649.46
|
| Rate for Payer: United Healthcare Commercial |
$1,129.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$740.45
|
| Rate for Payer: Wellmark IA HMO WHPI |
$102.10
|
| Rate for Payer: Wellmark IA PPO |
$112.46
|
|
|
DIABETES WITH CC
|
Facility
|
IP
|
$7,676.91
|
|
|
Service Code
|
MSDRG 638
|
| Min. Negotiated Rate |
$7,565.65 |
| Max. Negotiated Rate |
$7,676.91 |
| Rate for Payer: Amerigroup Medicaid |
$7,639.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7,565.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7,676.91
|
|
|
DIABETES WITH MCC
|
Facility
|
IP
|
$12,545.64
|
|
|
Service Code
|
MSDRG 637
|
| Min. Negotiated Rate |
$12,363.81 |
| Max. Negotiated Rate |
$12,545.64 |
| Rate for Payer: Amerigroup Medicaid |
$12,485.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,363.81
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,545.64
|
|
|
DIABETES WITHOUT CC/MCC
|
Facility
|
IP
|
$6,284.08
|
|
|
Service Code
|
MSDRG 639
|
| Min. Negotiated Rate |
$6,193.00 |
| Max. Negotiated Rate |
$6,284.08 |
| Rate for Payer: Amerigroup Medicaid |
$6,253.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,193.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,284.08
|
|
|
DIAGNOSTIC ANOSCOPY SPX
|
Professional
|
Both
|
$211.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
7982769
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$80.43 |
| Max. Negotiated Rate |
$266.90 |
| Rate for Payer: Amerigroup Medicaid |
$81.22
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$80.43
|
| Rate for Payer: Medical Associates Commercial |
$158.25
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$80.82
|
| Rate for Payer: Partners Health Alliance Commercial |
$158.25
|
| Rate for Payer: United Healthcare Commercial |
$154.42
|
| Rate for Payer: Wellmark IA HMO WHPI |
$226.90
|
| Rate for Payer: Wellmark IA PPO |
$266.90
|
|
|
Diaper Cream Compound [VDMC]
|
Facility
|
OP
|
$8.87
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23278189
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$7.98 |
| Rate for Payer: Aetna of IA Commercial |
$7.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.98
|
| Rate for Payer: Aetna of IA Medicare |
$5.05
|
| Rate for Payer: Amerigroup Medicaid |
$5.12
|
| Rate for Payer: Amerigroup Medicare |
$4.03
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6.65
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.99
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.07
|
| Rate for Payer: Medical Associates Commercial |
$6.65
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.99
|
| Rate for Payer: Midlands Choice Commercial |
$6.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.14
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.59
|
| Rate for Payer: United Healthcare Commercial |
$7.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.23
|
|
|
Diaper Cream Compound [VDMC]
|
Facility
|
IP
|
$8.87
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23278189
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$7.98 |
| Rate for Payer: Aetna of IA Commercial |
$7.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$7.98
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$6.65
|
| Rate for Payer: Medical Associates Commercial |
$6.65
|
| Rate for Payer: Midlands Choice Commercial |
$6.21
|
| Rate for Payer: United Healthcare Commercial |
$7.98
|
|
|
diazepam 2 mg Tab [VDMC]
|
Facility
|
IP
|
$3.21
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10382236
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna of IA Commercial |
$2.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.89
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.41
|
| Rate for Payer: Medical Associates Commercial |
$2.41
|
| Rate for Payer: Midlands Choice Commercial |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
|
|
diazepam 2 mg Tab [VDMC]
|
Facility
|
OP
|
$3.21
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10382236
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna of IA Commercial |
$2.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.89
|
| Rate for Payer: Aetna of IA Medicare |
$1.83
|
| Rate for Payer: Amerigroup Medicaid |
$1.85
|
| Rate for Payer: Amerigroup Medicare |
$1.46
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.83
|
| Rate for Payer: Medical Associates Commercial |
$2.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.44
|
| Rate for Payer: Midlands Choice Commercial |
$2.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.89
|
|
|
diazePAM 5 mg/mL 10 ml MDV vial [VDMC]
|
Facility
|
IP
|
$227.42
|
|
|
Service Code
|
HCPCS J3360
|
| Hospital Charge Code |
14377411
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$159.19 |
| Max. Negotiated Rate |
$204.68 |
| Rate for Payer: Aetna of IA Commercial |
$204.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$204.68
|
| Rate for Payer: Cash Price |
$181.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$170.56
|
| Rate for Payer: Medical Associates Commercial |
$170.56
|
| Rate for Payer: Midlands Choice Commercial |
$159.19
|
| Rate for Payer: United Healthcare Commercial |
$204.68
|
|
|
diazePAM 5 mg/mL 10 ml MDV vial [VDMC]
|
Facility
|
OP
|
$227.42
|
|
|
Service Code
|
HCPCS J3360
|
| Hospital Charge Code |
14377411
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$102.34 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$204.68
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$204.68
|
| Rate for Payer: Aetna of IA Medicare |
$129.63
|
| Rate for Payer: Amerigroup Medicaid |
$131.18
|
| Rate for Payer: Amerigroup Medicare |
$103.36
|
| Rate for Payer: Cash Price |
$181.94
|
| Rate for Payer: Cash Price |
$181.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$170.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$102.34
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$129.90
|
| Rate for Payer: Medical Associates Commercial |
$170.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$102.34
|
| Rate for Payer: Midlands Choice Commercial |
$159.19
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$131.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$117.69
|
| Rate for Payer: United Healthcare Commercial |
$204.68
|
| Rate for Payer: United Healthcare Managed Medicare |
$134.18
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
