|
valsartan 160 mg Tab
|
Facility
OP
|
$1.90
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna of IA Commercial |
$1.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.71
|
| Rate for Payer: Aetna of IA Medicare |
$1.08
|
| Rate for Payer: Amerigroup Medicaid |
$0.96
|
| Rate for Payer: Amerigroup Medicare |
$0.96
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.95
|
| Rate for Payer: Medical Associates Commercial |
$1.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$1.33
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$1.71
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.12
|
|
|
valsartan 160 mg Tab
|
Facility
IP
|
$1.90
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43702521
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.33 |
| Max. Negotiated Rate |
$1.71 |
| Rate for Payer: Aetna of IA Commercial |
$1.71
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.71
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.42
|
| Rate for Payer: Medical Associates Commercial |
$1.42
|
| Rate for Payer: Midlands Choice Commercial |
$1.33
|
| Rate for Payer: United Healthcare Commercial |
$1.71
|
|
|
valsartan 40 mg Tab
|
Facility
IP
|
$1.71
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43723470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.20 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
|
|
valsartan 40 mg Tab
|
Facility
OP
|
$1.71
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43723470
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna of IA Commercial |
$1.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.54
|
| Rate for Payer: Aetna of IA Medicare |
$0.97
|
| Rate for Payer: Amerigroup Medicaid |
$0.86
|
| Rate for Payer: Amerigroup Medicare |
$0.86
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.85
|
| Rate for Payer: Medical Associates Commercial |
$1.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.86
|
| Rate for Payer: Midlands Choice Commercial |
$1.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.87
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.28
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.01
|
|
|
vancomycin 125 mg Cap
|
Facility
IP
|
$6.05
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43710058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna of IA Commercial |
$5.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.44
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.54
|
| Rate for Payer: Medical Associates Commercial |
$4.54
|
| Rate for Payer: Midlands Choice Commercial |
$4.24
|
| Rate for Payer: United Healthcare Commercial |
$5.44
|
|
|
vancomycin 125 mg Cap
|
Facility
OP
|
$6.05
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43710058
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$5.44 |
| Rate for Payer: Aetna of IA Commercial |
$5.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$5.44
|
| Rate for Payer: Aetna of IA Medicare |
$3.45
|
| Rate for Payer: Amerigroup Medicaid |
$3.05
|
| Rate for Payer: Amerigroup Medicare |
$3.06
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$4.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.02
|
| Rate for Payer: Medical Associates Commercial |
$4.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.02
|
| Rate for Payer: Midlands Choice Commercial |
$4.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$4.54
|
| Rate for Payer: United Healthcare Commercial |
$5.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$3.57
|
|
|
vancomycin 1 g IV SDV Inj
|
Facility
IP
|
$32.81
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.97 |
| Max. Negotiated Rate |
$29.53 |
| Rate for Payer: Aetna of IA Commercial |
$29.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.53
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.61
|
| Rate for Payer: Medical Associates Commercial |
$24.61
|
| Rate for Payer: Midlands Choice Commercial |
$22.97
|
| Rate for Payer: United Healthcare Commercial |
$29.53
|
|
|
vancomycin 1 g IV SDV Inj
|
Facility
OP
|
$32.81
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43701008
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$29.53 |
| Rate for Payer: Aetna of IA Commercial |
$29.53
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$29.53
|
| Rate for Payer: Aetna of IA Medicare |
$18.70
|
| Rate for Payer: Amerigroup Medicaid |
$16.56
|
| Rate for Payer: Amerigroup Medicare |
$16.57
|
| Rate for Payer: Cash Price |
$26.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$24.61
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$16.40
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$16.40
|
| Rate for Payer: Medical Associates Commercial |
$24.61
|
| Rate for Payer: Medical Associates Managed Medicare |
$16.40
|
| Rate for Payer: Midlands Choice Commercial |
$22.97
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$16.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.61
|
| Rate for Payer: United Healthcare Commercial |
$29.53
|
| Rate for Payer: United Healthcare Managed Medicare |
$19.36
|
|
|
vancomycin 250 mg Cap
|
Facility
OP
|
$7.20
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43701610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna of IA Commercial |
$6.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.48
|
| Rate for Payer: Aetna of IA Medicare |
$4.10
|
| Rate for Payer: Amerigroup Medicaid |
$3.63
|
| Rate for Payer: Amerigroup Medicare |
$3.64
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.40
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.60
|
| Rate for Payer: Medical Associates Commercial |
$5.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.60
|
| Rate for Payer: Midlands Choice Commercial |
$5.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.65
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.40
|
| Rate for Payer: United Healthcare Commercial |
$6.48
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.25
|
|
|
vancomycin 250 mg Cap
|
Facility
IP
|
$7.20
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43701610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$6.48 |
| Rate for Payer: Aetna of IA Commercial |
$6.48
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.48
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.40
|
| Rate for Payer: Medical Associates Commercial |
$5.40
|
| Rate for Payer: Midlands Choice Commercial |
$5.04
|
| Rate for Payer: United Healthcare Commercial |
$6.48
|
|
|
vancomycin 500 mg IV SDV Inj
|
Facility
IP
|
$30.45
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43700576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Aetna of IA Commercial |
$27.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.40
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.84
|
| Rate for Payer: Medical Associates Commercial |
$22.84
|
| Rate for Payer: Midlands Choice Commercial |
$21.32
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
|
|
vancomycin 500 mg IV SDV Inj
|
Facility
OP
|
$30.45
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43700576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.22 |
| Max. Negotiated Rate |
$27.40 |
| Rate for Payer: Aetna of IA Commercial |
$27.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$27.40
|
| Rate for Payer: Aetna of IA Medicare |
$17.36
|
| Rate for Payer: Amerigroup Medicaid |
$15.37
|
| Rate for Payer: Amerigroup Medicare |
$15.38
|
| Rate for Payer: Cash Price |
$24.36
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$22.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.22
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.22
|
| Rate for Payer: Medical Associates Commercial |
$22.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.22
|
| Rate for Payer: Midlands Choice Commercial |
$21.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$22.84
|
| Rate for Payer: United Healthcare Commercial |
$27.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$17.97
|
|
|
Vancomycin HCL 1.25 gm/250 ml IV
|
Facility
IP
|
$110.93
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43700577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.65 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna of IA Commercial |
$99.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.84
|
| Rate for Payer: Cash Price |
$88.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.20
|
| Rate for Payer: Medical Associates Commercial |
$83.20
|
| Rate for Payer: Midlands Choice Commercial |
$77.65
|
| Rate for Payer: United Healthcare Commercial |
$99.84
|
|
|
Vancomycin HCL 1.25 gm/250 ml IV
|
Facility
OP
|
$110.93
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43700577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$99.84 |
| Rate for Payer: Aetna of IA Commercial |
$99.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$99.84
|
| Rate for Payer: Aetna of IA Medicare |
$63.23
|
| Rate for Payer: Amerigroup Medicaid |
$55.99
|
| Rate for Payer: Amerigroup Medicare |
$56.02
|
| Rate for Payer: Cash Price |
$88.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$83.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$55.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$55.44
|
| Rate for Payer: Medical Associates Commercial |
$83.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$55.46
|
| Rate for Payer: Midlands Choice Commercial |
$77.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$56.30
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.20
|
| Rate for Payer: United Healthcare Commercial |
$99.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$65.45
|
|
|
vancomycin HCL1.5 gm/300ml IV
|
Facility
IP
|
$123.13
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705956
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.19 |
| Max. Negotiated Rate |
$110.82 |
| Rate for Payer: Aetna of IA Commercial |
$110.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.82
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.35
|
| Rate for Payer: Medical Associates Commercial |
$92.35
|
| Rate for Payer: Midlands Choice Commercial |
$86.19
|
| Rate for Payer: United Healthcare Commercial |
$110.82
|
|
|
vancomycin HCL1.5 gm/300ml IV
|
Facility
OP
|
$123.13
|
|
|
Service Code
|
CPT A9270
|
| Hospital Charge Code |
43705956
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$110.82 |
| Rate for Payer: Aetna of IA Commercial |
$110.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$110.82
|
| Rate for Payer: Aetna of IA Medicare |
$70.18
|
| Rate for Payer: Amerigroup Medicaid |
$62.14
|
| Rate for Payer: Amerigroup Medicare |
$62.18
|
| Rate for Payer: Cash Price |
$98.50
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$92.35
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$61.56
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$61.54
|
| Rate for Payer: Medical Associates Commercial |
$92.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$61.56
|
| Rate for Payer: Midlands Choice Commercial |
$86.19
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.49
|
| Rate for Payer: Partners Health Alliance Commercial |
$92.35
|
| Rate for Payer: United Healthcare Commercial |
$110.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$72.65
|
|
|
Vancomycin HCL 1.75 gm/350ml IV
|
Facility
IP
|
$118.08
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43700554
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.66 |
| Max. Negotiated Rate |
$106.27 |
| Rate for Payer: Aetna of IA Commercial |
$106.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.27
|
| Rate for Payer: Cash Price |
$94.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.56
|
| Rate for Payer: Medical Associates Commercial |
$88.56
|
| Rate for Payer: Midlands Choice Commercial |
$82.66
|
| Rate for Payer: United Healthcare Commercial |
$106.27
|
|
|
Vancomycin HCL 1.75 gm/350ml IV
|
Facility
OP
|
$118.08
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43700554
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$106.27 |
| Rate for Payer: Aetna of IA Commercial |
$106.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$106.27
|
| Rate for Payer: Aetna of IA Medicare |
$67.31
|
| Rate for Payer: Amerigroup Medicaid |
$59.59
|
| Rate for Payer: Amerigroup Medicare |
$59.63
|
| Rate for Payer: Cash Price |
$94.47
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$88.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$59.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$59.02
|
| Rate for Payer: Medical Associates Commercial |
$88.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$59.04
|
| Rate for Payer: Midlands Choice Commercial |
$82.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$59.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$88.56
|
| Rate for Payer: United Healthcare Commercial |
$106.27
|
| Rate for Payer: United Healthcare Managed Medicare |
$69.67
|
|
|
Vancomycin HCL 1gm/200ml IV
|
Facility
OP
|
$98.75
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43700585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$88.88 |
| Rate for Payer: Aetna of IA Commercial |
$88.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.88
|
| Rate for Payer: Aetna of IA Medicare |
$56.29
|
| Rate for Payer: Amerigroup Medicaid |
$49.84
|
| Rate for Payer: Amerigroup Medicare |
$49.87
|
| Rate for Payer: Cash Price |
$79.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.06
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.36
|
| Rate for Payer: Medical Associates Commercial |
$74.06
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.38
|
| Rate for Payer: Midlands Choice Commercial |
$69.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.12
|
| Rate for Payer: Partners Health Alliance Commercial |
$74.06
|
| Rate for Payer: United Healthcare Commercial |
$88.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$58.26
|
|
|
Vancomycin HCL 1gm/200ml IV
|
Facility
IP
|
$98.75
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43700585
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.12 |
| Max. Negotiated Rate |
$88.88 |
| Rate for Payer: Aetna of IA Commercial |
$88.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.88
|
| Rate for Payer: Cash Price |
$79.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$74.06
|
| Rate for Payer: Medical Associates Commercial |
$74.06
|
| Rate for Payer: Midlands Choice Commercial |
$69.12
|
| Rate for Payer: United Healthcare Commercial |
$88.88
|
|
|
Vancomycin HCL 750mg/150ml IV
|
Facility
OP
|
$86.62
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43700578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.29 |
| Max. Negotiated Rate |
$77.96 |
| Rate for Payer: Aetna of IA Commercial |
$77.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.96
|
| Rate for Payer: Aetna of IA Medicare |
$49.37
|
| Rate for Payer: Amerigroup Medicaid |
$43.72
|
| Rate for Payer: Amerigroup Medicare |
$43.74
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$43.31
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.29
|
| Rate for Payer: Medical Associates Commercial |
$64.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$43.31
|
| Rate for Payer: Midlands Choice Commercial |
$60.63
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$43.96
|
| Rate for Payer: Partners Health Alliance Commercial |
$64.96
|
| Rate for Payer: United Healthcare Commercial |
$77.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$51.11
|
|
|
Vancomycin HCL 750mg/150ml IV
|
Facility
IP
|
$86.62
|
|
|
Service Code
|
CPT J3370
|
| Hospital Charge Code |
43700578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.63 |
| Max. Negotiated Rate |
$77.96 |
| Rate for Payer: Aetna of IA Commercial |
$77.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.96
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.96
|
| Rate for Payer: Medical Associates Commercial |
$64.96
|
| Rate for Payer: Midlands Choice Commercial |
$60.63
|
| Rate for Payer: United Healthcare Commercial |
$77.96
|
|
|
VANCOMYCIN LEVEL
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
1634896
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$65.11
|
| Rate for Payer: Amerigroup Medicare |
$65.14
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.47
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
| Rate for Payer: Wellmark IA HMO |
$49.60
|
| Rate for Payer: Wellmark IA PPO |
$54.56
|
|
|
VANCOMYCIN LEVEL
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
1634897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.30 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
|
|
VANCOMYCIN LEVEL
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
1634897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Aetna of IA Commercial |
$116.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$116.10
|
| Rate for Payer: Aetna of IA Medicare |
$73.53
|
| Rate for Payer: Amerigroup Medicaid |
$65.11
|
| Rate for Payer: Amerigroup Medicare |
$65.14
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$96.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$64.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$64.47
|
| Rate for Payer: Medical Associates Commercial |
$96.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$90.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$65.47
|
| Rate for Payer: Partners Health Alliance Commercial |
$96.75
|
| Rate for Payer: United Healthcare Commercial |
$116.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$76.11
|
| Rate for Payer: Wellmark IA HMO |
$49.60
|
| Rate for Payer: Wellmark IA PPO |
$54.56
|
|
