|
Cirrhosis and Alcoholic Hepatitis With CC
|
Facility
|
IP
|
$9,871.94
|
|
|
Service Code
|
MS-DRG 433
|
| Hospital Charge Code |
259
|
| Min. Negotiated Rate |
$9,728.87 |
| Max. Negotiated Rate |
$9,871.94 |
| Rate for Payer: Amerigroup Medicaid |
$9,824.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$9,728.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$9,871.94
|
|
|
Cirrhosis and Alcoholic Hepatitis With MCC
|
Facility
|
IP
|
$15,240.98
|
|
|
Service Code
|
MS-DRG 432
|
| Hospital Charge Code |
258
|
| Min. Negotiated Rate |
$15,020.09 |
| Max. Negotiated Rate |
$15,240.98 |
| Rate for Payer: Amerigroup Medicaid |
$15,167.35
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15,020.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15,240.98
|
|
|
Cirrhosis and Alcoholic Hepatitis Without CC/MCC
|
Facility
|
IP
|
$6,280.44
|
|
|
Service Code
|
MS-DRG 434
|
| Hospital Charge Code |
260
|
| Min. Negotiated Rate |
$6,189.42 |
| Max. Negotiated Rate |
$6,280.44 |
| Rate for Payer: Amerigroup Medicaid |
$6,250.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6,189.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6,280.44
|
|
|
CISplatin 1 mg/mL Sol 100 ml MDV [VDMC]
|
Facility
|
IP
|
$115.16
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
13968901
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$80.61 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna of IA Commercial |
$103.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.64
|
| Rate for Payer: Cash Price |
$92.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.37
|
| Rate for Payer: Medical Associates Commercial |
$86.37
|
| Rate for Payer: Midlands Choice Commercial |
$80.61
|
| Rate for Payer: United Healthcare Commercial |
$103.64
|
|
|
CISplatin 1 mg/mL Sol 100 ml MDV [VDMC]
|
Facility
|
OP
|
$115.16
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
13968901
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$57.56 |
| Max. Negotiated Rate |
$103.64 |
| Rate for Payer: Aetna of IA Commercial |
$103.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$103.64
|
| Rate for Payer: Aetna of IA Medicare |
$65.64
|
| Rate for Payer: Amerigroup Medicaid |
$58.12
|
| Rate for Payer: Amerigroup Medicare |
$58.16
|
| Rate for Payer: Cash Price |
$92.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$86.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$57.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$57.56
|
| Rate for Payer: Medical Associates Commercial |
$86.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$57.58
|
| Rate for Payer: Midlands Choice Commercial |
$80.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$58.44
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$58.41
|
| Rate for Payer: Oscar Health of IA Commercial |
$86.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$86.37
|
| Rate for Payer: United Healthcare Commercial |
$103.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$67.94
|
|
|
citalopram 20 mg Tab [VDMC]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378190
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.59
|
| Rate for Payer: Amerigroup Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.58
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.59
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.59
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$0.88
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.69
|
|
|
citalopram 20 mg Tab [VDMC]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378190
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna of IA Commercial |
$1.05
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.05
|
| Rate for Payer: Cash Price |
$0.93
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.88
|
| Rate for Payer: Medical Associates Commercial |
$0.88
|
| Rate for Payer: Midlands Choice Commercial |
$0.82
|
| Rate for Payer: United Healthcare Commercial |
$1.05
|
|
|
CK
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
4010788
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$36.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$53.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
CK
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
4010788
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
CKMB
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
8093949
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
CKMB
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
8093949
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
CKMB and Index DMCL
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
8037513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Aetna of IA Medicare |
$79.23
|
| Rate for Payer: Amerigroup Medicaid |
$70.15
|
| Rate for Payer: Amerigroup Medicare |
$70.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$69.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.47
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$69.50
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.54
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$70.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$104.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$82.01
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
CKMB and Index DMCL
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
8037513
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$97.30 |
| Max. Negotiated Rate |
$125.10 |
| Rate for Payer: Aetna of IA Commercial |
$125.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$125.10
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$104.25
|
| Rate for Payer: Medical Associates Commercial |
$104.25
|
| Rate for Payer: Midlands Choice Commercial |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$125.10
|
|
|
CK MB DMCL
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
8037511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$36.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$53.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
CK MB DMCL
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
8037511
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
CK Total DMCL
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
8037512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.70 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
|
|
CK Total DMCL
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 82550
|
| Hospital Charge Code |
8037512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.46 |
| Max. Negotiated Rate |
$63.90 |
| Rate for Payer: Aetna of IA Commercial |
$63.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$63.90
|
| Rate for Payer: Aetna of IA Medicare |
$40.47
|
| Rate for Payer: Amerigroup Medicaid |
$35.83
|
| Rate for Payer: Amerigroup Medicare |
$35.86
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$53.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$35.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.49
|
| Rate for Payer: Medical Associates Commercial |
$53.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$35.50
|
| Rate for Payer: Midlands Choice Commercial |
$49.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$36.01
|
| Rate for Payer: Oscar Health of IA Commercial |
$53.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$63.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$41.89
|
| Rate for Payer: Wellmark IA HMO |
$20.46
|
| Rate for Payer: Wellmark IA PPO |
$22.51
|
|
|
clindamycin 150 mg Cap [VDMC]
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378332
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of IA Commercial |
$1.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.67
|
| Rate for Payer: Aetna of IA Medicare |
$1.06
|
| Rate for Payer: Amerigroup Medicaid |
$0.94
|
| Rate for Payer: Amerigroup Medicare |
$0.94
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.40
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.93
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$1.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.93
|
| Rate for Payer: Midlands Choice Commercial |
$1.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.94
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.94
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.40
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.10
|
|
|
clindamycin 150 mg Cap [VDMC]
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10378332
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna of IA Commercial |
$1.67
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.67
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.40
|
| Rate for Payer: Medical Associates Commercial |
$1.40
|
| Rate for Payer: Midlands Choice Commercial |
$1.30
|
| Rate for Payer: United Healthcare Commercial |
$1.67
|
|
|
clindamycin 300 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
OP
|
$76.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10378403
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.01 |
| Max. Negotiated Rate |
$68.44 |
| Rate for Payer: Aetna of IA Commercial |
$68.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.44
|
| Rate for Payer: Aetna of IA Medicare |
$43.35
|
| Rate for Payer: Amerigroup Medicaid |
$38.38
|
| Rate for Payer: Amerigroup Medicare |
$38.41
|
| Rate for Payer: Cash Price |
$60.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.04
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$38.01
|
| Rate for Payer: Medical Associates Commercial |
$57.04
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.02
|
| Rate for Payer: Midlands Choice Commercial |
$53.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$38.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$38.57
|
| Rate for Payer: Oscar Health of IA Commercial |
$57.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$57.04
|
| Rate for Payer: United Healthcare Commercial |
$68.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$44.87
|
|
|
clindamycin 300 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
IP
|
$76.05
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10378403
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$68.44 |
| Rate for Payer: Aetna of IA Commercial |
$68.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.44
|
| Rate for Payer: Cash Price |
$60.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.04
|
| Rate for Payer: Medical Associates Commercial |
$57.04
|
| Rate for Payer: Midlands Choice Commercial |
$53.24
|
| Rate for Payer: United Healthcare Commercial |
$68.44
|
|
|
clindamycin 600 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
OP
|
$66.38
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10378474
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$59.74 |
| Rate for Payer: Aetna of IA Commercial |
$59.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.74
|
| Rate for Payer: Aetna of IA Medicare |
$37.84
|
| Rate for Payer: Amerigroup Medicaid |
$33.50
|
| Rate for Payer: Amerigroup Medicare |
$33.52
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$33.19
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$33.18
|
| Rate for Payer: Medical Associates Commercial |
$49.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$33.19
|
| Rate for Payer: Midlands Choice Commercial |
$46.47
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.69
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$33.67
|
| Rate for Payer: Oscar Health of IA Commercial |
$49.78
|
| Rate for Payer: Partners Health Alliance Commercial |
$49.78
|
| Rate for Payer: United Healthcare Commercial |
$59.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$39.16
|
|
|
clindamycin 600 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
IP
|
$66.38
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10378474
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$46.47 |
| Max. Negotiated Rate |
$59.74 |
| Rate for Payer: Aetna of IA Commercial |
$59.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$59.74
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$49.78
|
| Rate for Payer: Medical Associates Commercial |
$49.78
|
| Rate for Payer: Midlands Choice Commercial |
$46.47
|
| Rate for Payer: United Healthcare Commercial |
$59.74
|
|
|
clindamycin 900 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
OP
|
$98.02
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
11881828
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$88.22 |
| Rate for Payer: Aetna of IA Commercial |
$88.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.22
|
| Rate for Payer: Aetna of IA Medicare |
$55.87
|
| Rate for Payer: Amerigroup Medicaid |
$49.47
|
| Rate for Payer: Amerigroup Medicare |
$49.50
|
| Rate for Payer: Cash Price |
$78.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$49.01
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$48.99
|
| Rate for Payer: Medical Associates Commercial |
$73.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$49.01
|
| Rate for Payer: Midlands Choice Commercial |
$68.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.75
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$49.72
|
| Rate for Payer: Oscar Health of IA Commercial |
$73.52
|
| Rate for Payer: Partners Health Alliance Commercial |
$73.52
|
| Rate for Payer: United Healthcare Commercial |
$88.22
|
| Rate for Payer: United Healthcare Managed Medicare |
$57.83
|
|
|
clindamycin 900 mg/50 mL-D5W IV SDV [VDMC]
|
Facility
|
IP
|
$98.02
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
11881828
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$68.61 |
| Max. Negotiated Rate |
$88.22 |
| Rate for Payer: Aetna of IA Commercial |
$88.22
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$88.22
|
| Rate for Payer: Cash Price |
$78.41
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$73.52
|
| Rate for Payer: Medical Associates Commercial |
$73.52
|
| Rate for Payer: Midlands Choice Commercial |
$68.61
|
| Rate for Payer: United Healthcare Commercial |
$88.22
|
|
