|
dextrose emergency syringe 50% IV Sol 50 mL [VDMC]
|
Facility
|
OP
|
$73.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10434776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.94 |
| Max. Negotiated Rate |
$66.51 |
| Rate for Payer: Aetna of IA Commercial |
$66.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.51
|
| Rate for Payer: Aetna of IA Medicare |
$42.12
|
| Rate for Payer: Amerigroup Medicaid |
$37.30
|
| Rate for Payer: Amerigroup Medicare |
$37.32
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.94
|
| Rate for Payer: Medical Associates Commercial |
$55.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.95
|
| Rate for Payer: Midlands Choice Commercial |
$51.73
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$37.50
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$37.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$55.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.42
|
| Rate for Payer: United Healthcare Commercial |
$66.51
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.60
|
|
|
dextrose emergency syringe 50% IV Sol 50 mL [VDMC]
|
Facility
|
IP
|
$73.90
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10434776
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$51.73 |
| Max. Negotiated Rate |
$66.51 |
| Rate for Payer: Aetna of IA Commercial |
$66.51
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.51
|
| Rate for Payer: Cash Price |
$59.12
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.42
|
| Rate for Payer: Medical Associates Commercial |
$55.42
|
| Rate for Payer: Midlands Choice Commercial |
$51.73
|
| Rate for Payer: United Healthcare Commercial |
$66.51
|
|
|
DIAB ED GROUP T19
|
Facility
|
OP
|
$1,022.00
|
|
|
Service Code
|
CPT S9455
|
| Hospital Charge Code |
8059033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$510.80 |
| 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 |
$515.80
|
| Rate for Payer: Amerigroup Medicare |
$516.11
|
| 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 |
$511.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$510.80
|
| Rate for Payer: Medical Associates Commercial |
$766.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$511.00
|
| Rate for Payer: Midlands Choice Commercial |
$715.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$518.66
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$518.36
|
| Rate for Payer: Oscar Health of IA Commercial |
$766.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$766.50
|
| Rate for Payer: United Healthcare Commercial |
$919.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$602.98
|
|
|
DIAB ED GROUP T19
|
Facility
|
IP
|
$1,022.00
|
|
|
Service Code
|
CPT 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
|
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-GROUP EA 30 MINUTE
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
5616793
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$45.48 |
| Max. Negotiated Rate |
$150.72 |
| 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 |
$45.93
|
| Rate for Payer: Amerigroup Medicare |
$45.96
|
| 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 |
$45.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$45.48
|
| Rate for Payer: Medical Associates Commercial |
$68.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$45.50
|
| Rate for Payer: Midlands Choice Commercial |
$63.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$46.18
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$46.16
|
| Rate for Payer: Oscar Health of IA Commercial |
$68.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$68.25
|
| Rate for Payer: United Healthcare Commercial |
$81.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$53.69
|
| Rate for Payer: Wellmark IA HMO |
$137.02
|
| Rate for Payer: Wellmark IA PPO |
$150.72
|
|
|
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 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: Molina Healthcare Managed Medicare |
$75.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$111.00
|
| 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 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: Molina Healthcare Managed Medicare |
$636.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$941.25
|
| 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
|
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 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 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: Molina Healthcare Managed Medicare |
$636.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$941.25
|
| 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 With CC
|
Facility
|
IP
|
$6,710.56
|
|
|
Service Code
|
MS-DRG 638
|
| Hospital Charge Code |
424
|
| Min. Negotiated Rate |
$6,613.30 |
| Max. Negotiated Rate |
$6,710.56 |
| Rate for Payer: Amerigroup Medicaid |
$6,678.14
|
| 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 |
$10,807.48 |
| Max. Negotiated Rate |
$10,966.41 |
| Rate for Payer: Amerigroup Medicaid |
$10,913.44
|
| 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 |
$5,413.45 |
| Max. Negotiated Rate |
$5,493.06 |
| Rate for Payer: Amerigroup Medicaid |
$5,466.52
|
| 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
|
Both
|
$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 |
$67.12
|
| Rate for Payer: Medical Associates Managed Medicare |
$37.29
|
| Rate for Payer: Midlands Choice Commercial |
$147.70
|
| Rate for Payer: Oscar Health of IA Commercial |
$64.51
|
| Rate for Payer: Partners Health Alliance Commercial |
$55.94
|
|
|
Diaper Cream Compound [VDMC]
|
Facility
|
OP
|
$8.87
|
|
|
Service Code
|
HCPCS A9270GY
|
| Hospital Charge Code |
23278189
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$4.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$6.65
|
| 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 [VDMC]
|
Facility
|
IP
|
$8.87
|
|
|
Service Code
|
HCPCS A9270GY
|
| 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
|
OP
|
$3.06
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10382236
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$1.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.30
|
| 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 2 mg Tab [VDMC]
|
Facility
|
IP
|
$3.06
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10382236
|
|
Hospital Revenue Code
|
259
|
| 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 5 mg/mL 10 ml MDV vial [VDMC]
|
Facility
|
OP
|
$194.78
|
|
|
Service Code
|
HCPCS J3360
|
| Hospital Charge Code |
14377411
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$98.79
|
| Rate for Payer: Oscar Health of IA Commercial |
$146.08
|
| 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 [VDMC]
|
Facility
|
IP
|
$194.78
|
|
|
Service Code
|
HCPCS J3360
|
| Hospital Charge Code |
14377411
|
|
Hospital Revenue Code
|
259
|
| 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 [VDMC]
|
Facility
|
OP
|
$154.24
|
|
|
Service Code
|
HCPCS J3360
|
| Hospital Charge Code |
10382374
|
|
Hospital Revenue Code
|
259
|
| 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: Molina Healthcare Managed Medicare |
$78.23
|
| Rate for Payer: Oscar Health of IA Commercial |
$115.68
|
| 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 [VDMC]
|
Facility
|
IP
|
$154.24
|
|
|
Service Code
|
HCPCS J3360
|
| Hospital Charge Code |
10382374
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$138.82 |
| Rate for Payer: Medical Associates Commercial |
$115.68
|
| 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: Midlands Choice Commercial |
$107.97
|
| Rate for Payer: United Healthcare Commercial |
$138.82
|
|
|
diazepam 5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10382305
|
|
Hospital Revenue Code
|
259
|
| 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
|
|
