|
Dextrose 5% in Water IV Sol 250 mL PVC FREE [VDMC]
|
Facility
|
IP
|
$73.61
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
10440572
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$51.53 |
| Max. Negotiated Rate |
$66.25 |
| Rate for Payer: Aetna of IA Commercial |
$66.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$66.25
|
| Rate for Payer: Cash Price |
$58.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.21
|
| Rate for Payer: Medical Associates Commercial |
$55.21
|
| Rate for Payer: Midlands Choice Commercial |
$51.53
|
| Rate for Payer: United Healthcare Commercial |
$66.25
|
|
|
Dextrose 5% in Water IV Sol 500 mL [VDMC]
|
Facility
|
IP
|
$63.70
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
10440639
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna of IA Commercial |
$57.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.33
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.77
|
| Rate for Payer: Medical Associates Commercial |
$47.77
|
| Rate for Payer: Midlands Choice Commercial |
$44.59
|
| Rate for Payer: United Healthcare Commercial |
$57.33
|
|
|
Dextrose 5% in Water IV Sol 500 mL [VDMC]
|
Facility
|
OP
|
$63.70
|
|
|
Service Code
|
HCPCS J7070
|
| Hospital Charge Code |
10440639
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$28.66 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna of IA Commercial |
$57.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$57.33
|
| Rate for Payer: Aetna of IA Medicare |
$36.31
|
| Rate for Payer: Amerigroup Medicaid |
$36.74
|
| Rate for Payer: Amerigroup Medicare |
$28.95
|
| Rate for Payer: Cash Price |
$50.96
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$47.77
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$28.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$36.39
|
| Rate for Payer: Medical Associates Commercial |
$47.77
|
| Rate for Payer: Medical Associates Managed Medicare |
$28.66
|
| Rate for Payer: Midlands Choice Commercial |
$44.59
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.96
|
| Rate for Payer: United Healthcare Commercial |
$57.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$37.58
|
|
|
Dextrose 5% with 0.2% NaCl IV Sol 1000 mL [VDMC]
|
Facility
|
OP
|
$87.32
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
22746066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$78.59 |
| Rate for Payer: Aetna of IA Commercial |
$78.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$78.59
|
| Rate for Payer: Aetna of IA Medicare |
$49.77
|
| Rate for Payer: Amerigroup Medicaid |
$50.37
|
| Rate for Payer: Amerigroup Medicare |
$39.69
|
| Rate for Payer: Cash Price |
$69.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$65.49
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$39.29
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.88
|
| Rate for Payer: Medical Associates Commercial |
$65.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$39.29
|
| Rate for Payer: Midlands Choice Commercial |
$61.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.61
|
| Rate for Payer: Partners Health Alliance Commercial |
$45.19
|
| Rate for Payer: United Healthcare Commercial |
$78.59
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.52
|
|
|
Dextrose 5% with 0.2% NaCl IV Sol 1000 mL [VDMC]
|
Facility
|
IP
|
$87.32
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
22746066
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$61.12 |
| Max. Negotiated Rate |
$78.59 |
| Rate for Payer: Aetna of IA Commercial |
$78.59
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$78.59
|
| Rate for Payer: Cash Price |
$69.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$65.49
|
| Rate for Payer: Medical Associates Commercial |
$65.49
|
| Rate for Payer: Midlands Choice Commercial |
$61.12
|
| Rate for Payer: United Healthcare Commercial |
$78.59
|
|
|
Dextrose 5% with 0.45% NaCl and KCl 20 mEq/l IV Sol 1000 mL [VDMC]
|
Facility
|
OP
|
$57.64
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
10440773
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.94 |
| Max. Negotiated Rate |
$51.88 |
| Rate for Payer: Aetna of IA Commercial |
$51.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.88
|
| Rate for Payer: Aetna of IA Medicare |
$32.85
|
| Rate for Payer: Amerigroup Medicaid |
$33.25
|
| Rate for Payer: Amerigroup Medicare |
$26.20
|
| Rate for Payer: Cash Price |
$46.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.23
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.92
|
| Rate for Payer: Medical Associates Commercial |
$43.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.94
|
| Rate for Payer: Midlands Choice Commercial |
$40.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$29.83
|
| Rate for Payer: United Healthcare Commercial |
$51.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.01
|
|
|
Dextrose 5% with 0.45% NaCl and KCl 20 mEq/l IV Sol 1000 mL [VDMC]
|
Facility
|
IP
|
$57.64
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
10440773
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.35 |
| Max. Negotiated Rate |
$51.88 |
| Rate for Payer: Aetna of IA Commercial |
$51.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.88
|
| Rate for Payer: Cash Price |
$46.11
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.23
|
| Rate for Payer: Medical Associates Commercial |
$43.23
|
| Rate for Payer: Midlands Choice Commercial |
$40.35
|
| Rate for Payer: United Healthcare Commercial |
$51.88
|
|
|
Dextrose 5% with 0.45% NaCl and KCl 40 mEq/l IV Sol 1000 mL [VDMC]
|
Facility
|
OP
|
$59.76
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
10440840
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.89 |
| Max. Negotiated Rate |
$53.78 |
| Rate for Payer: Aetna of IA Commercial |
$53.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.78
|
| Rate for Payer: Aetna of IA Medicare |
$34.06
|
| Rate for Payer: Amerigroup Medicaid |
$34.47
|
| Rate for Payer: Amerigroup Medicare |
$27.16
|
| Rate for Payer: Cash Price |
$47.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.82
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$26.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$34.13
|
| Rate for Payer: Medical Associates Commercial |
$44.82
|
| Rate for Payer: Medical Associates Managed Medicare |
$26.89
|
| Rate for Payer: Midlands Choice Commercial |
$41.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$34.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$30.93
|
| Rate for Payer: United Healthcare Commercial |
$53.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$35.26
|
|
|
Dextrose 5% with 0.45% NaCl and KCl 40 mEq/l IV Sol 1000 mL [VDMC]
|
Facility
|
IP
|
$59.76
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
10440840
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$41.83 |
| Max. Negotiated Rate |
$53.78 |
| Rate for Payer: Aetna of IA Commercial |
$53.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$53.78
|
| Rate for Payer: Cash Price |
$47.81
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$44.82
|
| Rate for Payer: Medical Associates Commercial |
$44.82
|
| Rate for Payer: Midlands Choice Commercial |
$41.83
|
| Rate for Payer: United Healthcare Commercial |
$53.78
|
|
|
Dextrose 5% with 0.45% NaCl IV Sol 1000 mL [VDMC]
|
Facility
|
OP
|
$74.52
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
10440907
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.53 |
| Max. Negotiated Rate |
$67.07 |
| Rate for Payer: Aetna of IA Commercial |
$67.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.07
|
| Rate for Payer: Aetna of IA Medicare |
$42.48
|
| Rate for Payer: Amerigroup Medicaid |
$42.98
|
| Rate for Payer: Amerigroup Medicare |
$33.87
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.57
|
| Rate for Payer: Medical Associates Commercial |
$55.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.53
|
| Rate for Payer: Midlands Choice Commercial |
$52.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.56
|
| Rate for Payer: United Healthcare Commercial |
$67.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.97
|
|
|
Dextrose 5% with 0.45% NaCl IV Sol 1000 mL [VDMC]
|
Facility
|
IP
|
$74.52
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
10440907
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$67.07 |
| Rate for Payer: Aetna of IA Commercial |
$67.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.07
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.89
|
| Rate for Payer: Medical Associates Commercial |
$55.89
|
| Rate for Payer: Midlands Choice Commercial |
$52.16
|
| Rate for Payer: United Healthcare Commercial |
$67.07
|
|
|
Dextrose 5% with 0.9% NaCl intravenous solution 1000mL [VDMC]
|
Facility
|
OP
|
$74.52
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
11220542
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.53 |
| Max. Negotiated Rate |
$67.07 |
| Rate for Payer: Aetna of IA Commercial |
$67.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.07
|
| Rate for Payer: Aetna of IA Medicare |
$42.48
|
| Rate for Payer: Amerigroup Medicaid |
$42.98
|
| Rate for Payer: Amerigroup Medicare |
$33.87
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$42.57
|
| Rate for Payer: Medical Associates Commercial |
$55.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.53
|
| Rate for Payer: Midlands Choice Commercial |
$52.16
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.56
|
| Rate for Payer: United Healthcare Commercial |
$67.07
|
| Rate for Payer: United Healthcare Managed Medicare |
$43.97
|
|
|
Dextrose 5% with 0.9% NaCl intravenous solution 1000mL [VDMC]
|
Facility
|
IP
|
$74.52
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
11220542
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$52.16 |
| Max. Negotiated Rate |
$67.07 |
| Rate for Payer: Aetna of IA Commercial |
$67.07
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$67.07
|
| Rate for Payer: Cash Price |
$59.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$55.89
|
| Rate for Payer: Medical Associates Commercial |
$55.89
|
| Rate for Payer: Midlands Choice Commercial |
$52.16
|
| Rate for Payer: United Healthcare Commercial |
$67.07
|
|
|
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 |
$58.95 |
| 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: 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 |
$38.65
|
|
|
Dextrose 5% with 0.9% NaCl intravenous solution 500 mL [VDMC]
|
Facility
|
IP
|
$65.50
|
|
|
Service Code
|
HCPCS J7042
|
| Hospital Charge Code |
11220493
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$45.85 |
| Max. Negotiated Rate |
$58.95 |
| Rate for Payer: Aetna of IA Commercial |
$58.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$58.95
|
| Rate for Payer: Cash Price |
$52.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.12
|
| Rate for Payer: Medical Associates Commercial |
$49.12
|
| Rate for Payer: Midlands Choice Commercial |
$45.85
|
| Rate for Payer: United Healthcare Commercial |
$58.95
|
|
|
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 |
$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: 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: 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
|
|
|
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
|
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
|
|
|
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
|
|
|
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
|
|
|
DIAB ED GROUP T19
|
Facility
|
OP
|
$1,022.00
|
|
|
Service Code
|
HCPCS S9455
|
| Hospital Charge Code |
8059033
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$459.90 |
| 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: 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
|
|
|
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 |
$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: 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: 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
|
|
|
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 |
$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: 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: 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
|
|
|
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
|
|
