|
carvedilol 12.5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.08
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374624
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Aetna of IA Commercial |
$0.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.97
|
| Rate for Payer: Aetna of IA Medicare |
$0.62
|
| Rate for Payer: Amerigroup Medicaid |
$0.55
|
| Rate for Payer: Amerigroup Medicare |
$0.55
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.81
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.54
|
| Rate for Payer: Medical Associates Commercial |
$0.81
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.54
|
| Rate for Payer: Midlands Choice Commercial |
$0.76
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.55
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.55
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.81
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.64
|
|
|
carvedilol 25 mg Tab UD [VDMC]
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23268132
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of IA Commercial |
$1.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.14
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Midlands Choice Commercial |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$1.14
|
|
|
carvedilol 25 mg Tab UD [VDMC]
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23268132
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna of IA Commercial |
$1.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.14
|
| Rate for Payer: Aetna of IA Medicare |
$0.72
|
| Rate for Payer: Amerigroup Medicaid |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.64
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.64
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.64
|
| Rate for Payer: Midlands Choice Commercial |
$0.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.95
|
| Rate for Payer: United Healthcare Commercial |
$1.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.75
|
|
|
carvedilol 6.25 mg Tab [VDMC]
|
Facility
|
IP
|
$1.07
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374764
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of IA Commercial |
$0.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.96
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.80
|
| Rate for Payer: Medical Associates Commercial |
$0.80
|
| Rate for Payer: Midlands Choice Commercial |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$0.96
|
|
|
carvedilol 6.25 mg Tab [VDMC]
|
Facility
|
OP
|
$1.07
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374764
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna of IA Commercial |
$0.96
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.96
|
| Rate for Payer: Aetna of IA Medicare |
$0.61
|
| Rate for Payer: Amerigroup Medicaid |
$0.54
|
| Rate for Payer: Amerigroup Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.53
|
| Rate for Payer: Medical Associates Commercial |
$0.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.54
|
| Rate for Payer: Midlands Choice Commercial |
$0.75
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.80
|
| Rate for Payer: United Healthcare Commercial |
$0.96
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.63
|
|
|
castor oil 100% Liq [VDMC]
|
Facility
|
IP
|
$10.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221292
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$9.43 |
| Rate for Payer: Aetna of IA Commercial |
$9.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.43
|
| Rate for Payer: Cash Price |
$8.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.86
|
| Rate for Payer: Medical Associates Commercial |
$7.86
|
| Rate for Payer: Midlands Choice Commercial |
$7.34
|
| Rate for Payer: United Healthcare Commercial |
$9.43
|
|
|
castor oil 100% Liq [VDMC]
|
Facility
|
OP
|
$10.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11221292
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$9.43 |
| Rate for Payer: Aetna of IA Commercial |
$9.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$9.43
|
| Rate for Payer: Aetna of IA Medicare |
$5.97
|
| Rate for Payer: Amerigroup Medicaid |
$5.29
|
| Rate for Payer: Amerigroup Medicare |
$5.29
|
| Rate for Payer: Cash Price |
$8.38
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.86
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.24
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.24
|
| Rate for Payer: Medical Associates Commercial |
$7.86
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.24
|
| Rate for Payer: Midlands Choice Commercial |
$7.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.32
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$5.32
|
| Rate for Payer: Oscar Health of IA Commercial |
$7.86
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.86
|
| Rate for Payer: United Healthcare Commercial |
$9.43
|
| Rate for Payer: United Healthcare Managed Medicare |
$6.18
|
|
|
CBC NO DIFF
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
4004795
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
|
|
CBC NO DIFF
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
4004795
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.86 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Aetna of IA Commercial |
$59.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.40
|
| Rate for Payer: Aetna of IA Medicare |
$37.62
|
| Rate for Payer: Amerigroup Medicaid |
$33.31
|
| Rate for Payer: Amerigroup Medicare |
$33.33
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.99
|
| Rate for Payer: Medical Associates Commercial |
$49.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.00
|
| Rate for Payer: Midlands Choice Commercial |
$46.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.50
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$33.48
|
| Rate for Payer: Oscar Health of IA Commercial |
$49.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Commercial |
$59.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$38.94
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
CBC WITH DIFF
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
4004796
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of IA Commercial |
$72.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$72.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.00
|
| Rate for Payer: Medical Associates Commercial |
$60.00
|
| Rate for Payer: Midlands Choice Commercial |
$56.00
|
| Rate for Payer: United Healthcare Commercial |
$72.00
|
|
|
CBC WITH DIFF
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 85025
|
| Hospital Charge Code |
4004796
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.86 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna of IA Commercial |
$72.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$72.00
|
| Rate for Payer: Aetna of IA Medicare |
$45.60
|
| Rate for Payer: Amerigroup Medicaid |
$40.38
|
| Rate for Payer: Amerigroup Medicare |
$40.40
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$40.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$39.98
|
| Rate for Payer: Medical Associates Commercial |
$60.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.00
|
| Rate for Payer: Midlands Choice Commercial |
$56.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$40.58
|
| Rate for Payer: Oscar Health of IA Commercial |
$60.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.00
|
| Rate for Payer: United Healthcare Commercial |
$72.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$47.20
|
| Rate for Payer: Wellmark IA HMO |
$32.86
|
| Rate for Payer: Wellmark IA PPO |
$36.15
|
|
|
C. Diff Toxin and Ag
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
8507515
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.99 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Aetna of IA Medicare |
$33.06
|
| Rate for Payer: Amerigroup Medicaid |
$29.27
|
| Rate for Payer: Amerigroup Medicare |
$29.29
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$28.99
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.00
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.44
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$29.42
|
| Rate for Payer: Oscar Health of IA Commercial |
$43.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.50
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.22
|
| Rate for Payer: Wellmark IA HMO |
$31.00
|
| Rate for Payer: Wellmark IA PPO |
$34.10
|
|
|
C. Diff Toxin and Ag
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
8507515
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna of IA Commercial |
$52.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.20
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.50
|
| Rate for Payer: Medical Associates Commercial |
$43.50
|
| Rate for Payer: Midlands Choice Commercial |
$40.60
|
| Rate for Payer: United Healthcare Commercial |
$52.20
|
|
|
cefadroxil 500 mg Cap [VDMC]
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374904
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Aetna of IA Medicare |
$1.02
|
| Rate for Payer: Amerigroup Medicaid |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.90
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.90
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.91
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.91
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.34
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.06
|
|
|
cefadroxil 500 mg Cap [VDMC]
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10374904
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna of IA Commercial |
$1.61
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.61
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.34
|
| Rate for Payer: Medical Associates Commercial |
$1.34
|
| Rate for Payer: Midlands Choice Commercial |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.61
|
|
|
ceFAZolin 1 g/50 mL IV Premix [VDMC]
|
Facility
|
IP
|
$94.78
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
10375042
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$66.35 |
| Max. Negotiated Rate |
$85.30 |
| Rate for Payer: Aetna of IA Commercial |
$85.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.30
|
| Rate for Payer: Cash Price |
$75.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.08
|
| Rate for Payer: Medical Associates Commercial |
$71.08
|
| Rate for Payer: Midlands Choice Commercial |
$66.35
|
| Rate for Payer: United Healthcare Commercial |
$85.30
|
|
|
ceFAZolin 1 g/50 mL IV Premix [VDMC]
|
Facility
|
OP
|
$94.78
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
10375042
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$47.37 |
| Max. Negotiated Rate |
$85.30 |
| Rate for Payer: Aetna of IA Commercial |
$85.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$85.30
|
| Rate for Payer: Aetna of IA Medicare |
$54.02
|
| Rate for Payer: Amerigroup Medicaid |
$47.84
|
| Rate for Payer: Amerigroup Medicare |
$47.86
|
| Rate for Payer: Cash Price |
$75.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$71.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$47.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$47.37
|
| Rate for Payer: Medical Associates Commercial |
$71.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$47.39
|
| Rate for Payer: Midlands Choice Commercial |
$66.35
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$48.10
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$48.07
|
| Rate for Payer: Oscar Health of IA Commercial |
$71.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$71.08
|
| Rate for Payer: United Healthcare Commercial |
$85.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$55.92
|
|
|
ceFAZolin 1 g SDV Inj [VDMC]
|
Facility
|
OP
|
$25.90
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
10374973
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna of IA Commercial |
$23.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.31
|
| Rate for Payer: Aetna of IA Medicare |
$14.76
|
| Rate for Payer: Amerigroup Medicaid |
$13.07
|
| Rate for Payer: Amerigroup Medicare |
$13.08
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12.94
|
| Rate for Payer: Medical Associates Commercial |
$19.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.95
|
| Rate for Payer: Midlands Choice Commercial |
$18.13
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$13.14
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$13.14
|
| Rate for Payer: Oscar Health of IA Commercial |
$19.42
|
| Rate for Payer: Partners Health Alliance Commercial |
$19.42
|
| Rate for Payer: United Healthcare Commercial |
$23.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$15.28
|
|
|
ceFAZolin 1 g SDV Inj [VDMC]
|
Facility
|
IP
|
$25.90
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
10374973
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$23.31 |
| Rate for Payer: Aetna of IA Commercial |
$23.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$23.31
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$19.42
|
| Rate for Payer: Medical Associates Commercial |
$19.42
|
| Rate for Payer: Midlands Choice Commercial |
$18.13
|
| Rate for Payer: United Healthcare Commercial |
$23.31
|
|
|
ceFAZolin 2 g/50 mL Premix [VDMC]
|
Facility
|
OP
|
$100.38
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
10375111
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$50.17 |
| Max. Negotiated Rate |
$90.34 |
| Rate for Payer: Aetna of IA Commercial |
$90.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.34
|
| Rate for Payer: Aetna of IA Medicare |
$57.22
|
| Rate for Payer: Amerigroup Medicaid |
$50.66
|
| Rate for Payer: Amerigroup Medicare |
$50.69
|
| Rate for Payer: Cash Price |
$80.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$50.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$50.17
|
| Rate for Payer: Medical Associates Commercial |
$75.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$50.19
|
| Rate for Payer: Midlands Choice Commercial |
$70.27
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$50.94
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$50.91
|
| Rate for Payer: Oscar Health of IA Commercial |
$75.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.28
|
| Rate for Payer: United Healthcare Commercial |
$90.34
|
| Rate for Payer: United Healthcare Managed Medicare |
$59.22
|
|
|
ceFAZolin 2 g/50 mL Premix [VDMC]
|
Facility
|
IP
|
$100.38
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
10375111
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.27 |
| Max. Negotiated Rate |
$90.34 |
| Rate for Payer: Aetna of IA Commercial |
$90.34
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$90.34
|
| Rate for Payer: Cash Price |
$80.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$75.28
|
| Rate for Payer: Medical Associates Commercial |
$75.28
|
| Rate for Payer: Midlands Choice Commercial |
$70.27
|
| Rate for Payer: United Healthcare Commercial |
$90.34
|
|
|
ceFAZolin 500 mg SDV Inj [VDMC]
|
Facility
|
OP
|
$23.31
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
10375180
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$20.98 |
| Rate for Payer: Aetna of IA Commercial |
$20.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.98
|
| Rate for Payer: Aetna of IA Medicare |
$13.29
|
| Rate for Payer: Amerigroup Medicaid |
$11.76
|
| Rate for Payer: Amerigroup Medicare |
$11.77
|
| Rate for Payer: Cash Price |
$18.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.48
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$11.65
|
| Rate for Payer: Medical Associates Commercial |
$17.48
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.66
|
| Rate for Payer: Midlands Choice Commercial |
$16.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$11.83
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$11.82
|
| Rate for Payer: Oscar Health of IA Commercial |
$17.48
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.48
|
| Rate for Payer: United Healthcare Commercial |
$20.98
|
| Rate for Payer: United Healthcare Managed Medicare |
$13.75
|
|
|
ceFAZolin 500 mg SDV Inj [VDMC]
|
Facility
|
IP
|
$23.31
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
10375180
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$20.98 |
| Rate for Payer: Aetna of IA Commercial |
$20.98
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$20.98
|
| Rate for Payer: Cash Price |
$18.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$17.48
|
| Rate for Payer: Medical Associates Commercial |
$17.48
|
| Rate for Payer: Midlands Choice Commercial |
$16.32
|
| Rate for Payer: United Healthcare Commercial |
$20.98
|
|
|
cefdinir 250 mg/5 mL Pow 60ml Suspension[VDMC]
|
Facility
|
IP
|
$80.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
14015952
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$56.42 |
| Max. Negotiated Rate |
$72.54 |
| Rate for Payer: Aetna of IA Commercial |
$72.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$72.54
|
| Rate for Payer: Cash Price |
$64.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.45
|
| Rate for Payer: Medical Associates Commercial |
$60.45
|
| Rate for Payer: Midlands Choice Commercial |
$56.42
|
| Rate for Payer: United Healthcare Commercial |
$72.54
|
|
|
cefdinir 250 mg/5 mL Pow 60ml Suspension[VDMC]
|
Facility
|
OP
|
$80.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
14015952
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.28 |
| Max. Negotiated Rate |
$72.54 |
| Rate for Payer: Aetna of IA Commercial |
$72.54
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$72.54
|
| Rate for Payer: Aetna of IA Medicare |
$45.94
|
| Rate for Payer: Amerigroup Medicaid |
$40.68
|
| Rate for Payer: Amerigroup Medicare |
$40.70
|
| Rate for Payer: Cash Price |
$64.48
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$60.45
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$40.30
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.28
|
| Rate for Payer: Medical Associates Commercial |
$60.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.30
|
| Rate for Payer: Midlands Choice Commercial |
$56.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$40.90
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$40.88
|
| Rate for Payer: Oscar Health of IA Commercial |
$60.45
|
| Rate for Payer: Partners Health Alliance Commercial |
$60.45
|
| Rate for Payer: United Healthcare Commercial |
$72.54
|
| Rate for Payer: United Healthcare Managed Medicare |
$47.55
|
|
