|
DIABETES ED-GROUP EA 30 MINUTE
|
Facility
IP
|
$91.00
|
|
|
Service Code
|
CPT 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 INDIV EA 30 MINS
|
Facility
OP
|
$148.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
5616792
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$73.97 |
| Max. Negotiated Rate |
$218.24 |
| 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 |
$74.70
|
| Rate for Payer: Amerigroup Medicare |
$74.74
|
| 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 |
$74.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$73.97
|
| Rate for Payer: Medical Associates Commercial |
$111.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$74.00
|
| Rate for Payer: Midlands Choice Commercial |
$103.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$75.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$111.00
|
| Rate for Payer: United Healthcare Commercial |
$133.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$87.32
|
| Rate for Payer: Wellmark IA HMO |
$198.40
|
| Rate for Payer: Wellmark IA PPO |
$218.24
|
|
|
DIABETES ED INDIV EA 30 MINS
|
Facility
IP
|
$148.00
|
|
|
Service Code
|
CPT 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
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 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
|
Facility
OP
|
$1,255.00
|
|
|
Service Code
|
CPT S9455
|
| Hospital Charge Code |
8059032
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$627.25 |
| 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 |
$633.40
|
| Rate for Payer: Amerigroup Medicare |
$633.78
|
| 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 |
$627.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$627.25
|
| Rate for Payer: Medical Associates Commercial |
$941.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$627.50
|
| Rate for Payer: Midlands Choice Commercial |
$878.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$636.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$941.25
|
| Rate for Payer: United Healthcare Commercial |
$1,129.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$740.45
|
|
|
DIABETES ED IND PROGRAM T19
|
Facility
OP
|
$1,255.00
|
|
|
Service Code
|
CPT S9455
|
| Hospital Charge Code |
7803727
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$627.25 |
| 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 |
$633.40
|
| Rate for Payer: Amerigroup Medicare |
$633.78
|
| 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 |
$627.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$627.25
|
| Rate for Payer: Medical Associates Commercial |
$941.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$627.50
|
| Rate for Payer: Midlands Choice Commercial |
$878.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$636.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$941.25
|
| Rate for Payer: United Healthcare Commercial |
$1,129.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$740.45
|
|
|
DIABETES ED IND PROGRAM T19
|
Facility
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 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 With CC
|
Facility
IP
|
$6,710.56
|
|
|
Service Code
|
MS-DRG 638
|
| Hospital Charge Code |
424
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$6,710.56 |
| Rate for Payer: Amerigroup Medicaid |
$6,678.14
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,613.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,710.56
|
|
|
Diabetes With MCC
|
Facility
IP
|
$10,966.41
|
|
|
Service Code
|
MS-DRG 637
|
| Hospital Charge Code |
423
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$10,966.41 |
| Rate for Payer: Amerigroup Medicaid |
$10,913.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10,807.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10,966.41
|
|
|
Diabetes Without CC/MCC
|
Facility
IP
|
$5,493.06
|
|
|
Service Code
|
MS-DRG 639
|
| Hospital Charge Code |
425
|
| Min. Negotiated Rate |
$2,034.00 |
| Max. Negotiated Rate |
$5,493.06 |
| Rate for Payer: Amerigroup Medicaid |
$5,466.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,034.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5,413.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5,493.06
|
|
|
DIAGNOSTIC ANOSCOPY SPX
|
Professional
|
$211.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
7982769
|
|
Hospital Revenue Code
|
981
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$147.70 |
| Rate for Payer: Aetna of IA Medicare |
$37.29
|
| Rate for Payer: Amerigroup Medicaid |
$38.56
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Cash Price |
$168.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.75
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.04
|
| Rate for Payer: Medical Associates Commercial |
$70.85
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.29
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.94
|
| Rate for Payer: Wellmark IA HMO |
$78.00
|
| Rate for Payer: Wellmark IA PPO |
$92.00
|
|
|
Diaper Cream Compound
|
Facility
OP
|
$8.87
|
|
|
Service Code
|
CPT A9270GY
|
| Hospital Charge Code |
43700567
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.43 |
| 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 |
$5.06
|
| Rate for Payer: Amerigroup Medicaid |
$4.48
|
| Rate for Payer: Amerigroup Medicare |
$4.48
|
| 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 |
$4.44
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$4.43
|
| Rate for Payer: Medical Associates Commercial |
$6.65
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.44
|
| Rate for Payer: Midlands Choice Commercial |
$6.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$4.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.65
|
| Rate for Payer: United Healthcare Commercial |
$7.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.23
|
|
|
Diaper Cream Compound
|
Facility
IP
|
$8.87
|
|
|
Service Code
|
CPT A9270GY
|
| Hospital Charge Code |
43700567
|
|
Hospital Revenue Code
|
637
|
| 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
|
Facility
IP
|
$3.06
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna of IA Commercial |
$2.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.75
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.30
|
| Rate for Payer: Medical Associates Commercial |
$2.30
|
| Rate for Payer: Midlands Choice Commercial |
$2.14
|
| Rate for Payer: United Healthcare Commercial |
$2.75
|
|
|
diazepam 2 mg Tab
|
Facility
OP
|
$3.06
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702528
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.75 |
| Rate for Payer: Aetna of IA Commercial |
$2.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.75
|
| Rate for Payer: Aetna of IA Medicare |
$1.74
|
| Rate for Payer: Amerigroup Medicaid |
$1.54
|
| Rate for Payer: Amerigroup Medicare |
$1.55
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.30
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.53
|
| Rate for Payer: Medical Associates Commercial |
$2.30
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.53
|
| Rate for Payer: Midlands Choice Commercial |
$2.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.55
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.30
|
| Rate for Payer: United Healthcare Commercial |
$2.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.81
|
|
|
diazePAM 5 mg/mL 10 ml MDV vial
|
Facility
OP
|
$194.78
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
43700131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$175.30 |
| Rate for Payer: Aetna of IA Commercial |
$175.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$175.30
|
| Rate for Payer: Aetna of IA Medicare |
$111.02
|
| Rate for Payer: Amerigroup Medicaid |
$98.31
|
| Rate for Payer: Amerigroup Medicare |
$98.36
|
| Rate for Payer: Cash Price |
$155.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$146.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$97.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$97.35
|
| Rate for Payer: Medical Associates Commercial |
$146.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$97.39
|
| Rate for Payer: Midlands Choice Commercial |
$136.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$98.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$146.08
|
| Rate for Payer: United Healthcare Commercial |
$175.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$114.92
|
|
|
diazePAM 5 mg/mL 10 ml MDV vial
|
Facility
IP
|
$194.78
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
43700131
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$175.30 |
| Rate for Payer: Aetna of IA Commercial |
$175.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$175.30
|
| Rate for Payer: Cash Price |
$155.82
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$146.08
|
| Rate for Payer: Medical Associates Commercial |
$146.08
|
| Rate for Payer: Midlands Choice Commercial |
$136.35
|
| Rate for Payer: United Healthcare Commercial |
$175.30
|
|
|
diazepam 5 mg/mL 2 ml SDV Inj syringe
|
Facility
OP
|
$154.24
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
43755217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.09 |
| Max. Negotiated Rate |
$138.82 |
| Rate for Payer: Aetna of IA Commercial |
$138.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$138.82
|
| Rate for Payer: Aetna of IA Medicare |
$87.92
|
| Rate for Payer: Amerigroup Medicaid |
$77.84
|
| Rate for Payer: Amerigroup Medicare |
$77.89
|
| Rate for Payer: Cash Price |
$123.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.68
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$77.12
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$77.09
|
| Rate for Payer: Medical Associates Commercial |
$115.68
|
| Rate for Payer: Medical Associates Managed Medicare |
$77.12
|
| Rate for Payer: Midlands Choice Commercial |
$107.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$78.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$115.68
|
| Rate for Payer: United Healthcare Commercial |
$138.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$91.00
|
|
|
diazepam 5 mg/mL 2 ml SDV Inj syringe
|
Facility
IP
|
$154.24
|
|
|
Service Code
|
CPT J3360
|
| Hospital Charge Code |
43755217
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$138.82 |
| Rate for Payer: Aetna of IA Commercial |
$138.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$138.82
|
| Rate for Payer: Cash Price |
$123.39
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$115.68
|
| Rate for Payer: Medical Associates Commercial |
$115.68
|
| Rate for Payer: Midlands Choice Commercial |
$107.97
|
| Rate for Payer: United Healthcare Commercial |
$138.82
|
|
|
diazepam 5 mg Tab
|
Facility
OP
|
$3.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702530
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna of IA Commercial |
$2.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.84
|
| Rate for Payer: Aetna of IA Medicare |
$1.80
|
| Rate for Payer: Amerigroup Medicaid |
$1.59
|
| Rate for Payer: Amerigroup Medicare |
$1.60
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.58
|
| Rate for Payer: Medical Associates Commercial |
$2.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.58
|
| Rate for Payer: Midlands Choice Commercial |
$2.21
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.37
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.86
|
|
|
diazepam 5 mg Tab
|
Facility
IP
|
$3.16
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702530
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna of IA Commercial |
$2.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.84
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.37
|
| Rate for Payer: Medical Associates Commercial |
$2.37
|
| Rate for Payer: Midlands Choice Commercial |
$2.21
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
|
|
diclofenac sodium 50 mg Oral EC Tab
|
Facility
IP
|
$1.31
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of IA Commercial |
$1.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.18
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Midlands Choice Commercial |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$1.18
|
|
|
diclofenac sodium 50 mg Oral EC Tab
|
Facility
OP
|
$1.31
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702708
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.18 |
| Rate for Payer: Aetna of IA Commercial |
$1.18
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.18
|
| Rate for Payer: Aetna of IA Medicare |
$0.75
|
| Rate for Payer: Amerigroup Medicaid |
$0.66
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.65
|
| Rate for Payer: Medical Associates Commercial |
$0.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.66
|
| Rate for Payer: Midlands Choice Commercial |
$0.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.98
|
| Rate for Payer: United Healthcare Commercial |
$1.18
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.77
|
|
|
diclofenac sodium 75 mg DR Oral EC Tab
|
Facility
IP
|
$1.42
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of IA Commercial |
$1.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.28
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.06
|
| Rate for Payer: Medical Associates Commercial |
$1.06
|
| Rate for Payer: Midlands Choice Commercial |
$0.99
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
|
|
diclofenac sodium 75 mg DR Oral EC Tab
|
Facility
OP
|
$1.42
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701272
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna of IA Commercial |
$1.28
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.28
|
| Rate for Payer: Aetna of IA Medicare |
$0.81
|
| Rate for Payer: Amerigroup Medicaid |
$0.72
|
| Rate for Payer: Amerigroup Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.14
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.71
|
| Rate for Payer: Medical Associates Commercial |
$1.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.71
|
| Rate for Payer: Midlands Choice Commercial |
$0.99
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.72
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.06
|
| Rate for Payer: United Healthcare Commercial |
$1.28
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.84
|
|
