|
hydrocortisone 10 mg Tab [VDMC]
|
Facility
|
OP
|
$1.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10394252
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.41 |
| Rate for Payer: Aetna of IA Commercial |
$1.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.41
|
| Rate for Payer: Aetna of IA Medicare |
$0.89
|
| Rate for Payer: Amerigroup Medicaid |
$0.90
|
| Rate for Payer: Amerigroup Medicare |
$0.71
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$1.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.70
|
| Rate for Payer: Midlands Choice Commercial |
$1.09
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.90
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.92
|
|
|
hydrocortisone 250 mg Inj [VDMC]
|
Facility
|
IP
|
$155.68
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
10394522
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$108.98 |
| Max. Negotiated Rate |
$140.11 |
| Rate for Payer: Aetna of IA Commercial |
$140.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.11
|
| Rate for Payer: Cash Price |
$124.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$116.76
|
| Rate for Payer: Medical Associates Commercial |
$116.76
|
| Rate for Payer: Midlands Choice Commercial |
$108.98
|
| Rate for Payer: United Healthcare Commercial |
$140.11
|
|
|
hydrocortisone 250 mg Inj [VDMC]
|
Facility
|
OP
|
$155.68
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
10394522
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$70.06 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$140.11
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$140.11
|
| Rate for Payer: Aetna of IA Medicare |
$88.74
|
| Rate for Payer: Amerigroup Medicaid |
$89.80
|
| Rate for Payer: Amerigroup Medicare |
$70.76
|
| Rate for Payer: Cash Price |
$124.54
|
| Rate for Payer: Cash Price |
$124.54
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$116.76
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$70.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$88.92
|
| Rate for Payer: Medical Associates Commercial |
$116.76
|
| Rate for Payer: Medical Associates Managed Medicare |
$70.06
|
| Rate for Payer: Midlands Choice Commercial |
$108.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$90.23
|
| Rate for Payer: Partners Health Alliance Commercial |
$80.56
|
| Rate for Payer: United Healthcare Commercial |
$140.11
|
| Rate for Payer: United Healthcare Managed Medicare |
$91.85
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
hydrocortisone 25 mg Supp [VDMC]
|
Facility
|
OP
|
$9.71
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10394457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna of IA Commercial |
$8.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.74
|
| Rate for Payer: Aetna of IA Medicare |
$5.53
|
| Rate for Payer: Amerigroup Medicaid |
$5.60
|
| Rate for Payer: Amerigroup Medicare |
$4.41
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.37
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.54
|
| Rate for Payer: Medical Associates Commercial |
$7.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.37
|
| Rate for Payer: Midlands Choice Commercial |
$6.79
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.63
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$8.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.73
|
|
|
hydrocortisone 25 mg Supp [VDMC]
|
Facility
|
IP
|
$9.71
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10394457
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$8.74 |
| Rate for Payer: Aetna of IA Commercial |
$8.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.74
|
| Rate for Payer: Cash Price |
$7.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.28
|
| Rate for Payer: Medical Associates Commercial |
$7.28
|
| Rate for Payer: Midlands Choice Commercial |
$6.79
|
| Rate for Payer: United Healthcare Commercial |
$8.74
|
|
|
hydrocortisone/neomycin/polymyxin B otic 1%-0.35%-10000 units/mL Sus[VDMC]
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11800305
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$203.70 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Aetna of IA Commercial |
$261.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$261.90
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$218.25
|
| Rate for Payer: Medical Associates Commercial |
$218.25
|
| Rate for Payer: Midlands Choice Commercial |
$203.70
|
| Rate for Payer: United Healthcare Commercial |
$261.90
|
|
|
hydrocortisone/neomycin/polymyxin B otic 1%-0.35%-10000 units/mL Sus[VDMC]
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11800305
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$130.95 |
| Max. Negotiated Rate |
$261.90 |
| Rate for Payer: Aetna of IA Commercial |
$261.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$261.90
|
| Rate for Payer: Aetna of IA Medicare |
$165.87
|
| Rate for Payer: Amerigroup Medicaid |
$167.85
|
| Rate for Payer: Amerigroup Medicare |
$132.26
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$218.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$130.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$166.22
|
| Rate for Payer: Medical Associates Commercial |
$218.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$130.95
|
| Rate for Payer: Midlands Choice Commercial |
$203.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$168.66
|
| Rate for Payer: Partners Health Alliance Commercial |
$150.59
|
| Rate for Payer: United Healthcare Commercial |
$261.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$171.69
|
|
|
hydrocortisone/neomycin/polymyxin B otic 1%-0.35%-10000 units/mL Sus[VDMC]
|
Facility
|
OP
|
$345.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
14052150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$155.50 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: Aetna of IA Commercial |
$311.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.00
|
| Rate for Payer: Aetna of IA Medicare |
$196.97
|
| Rate for Payer: Amerigroup Medicaid |
$199.32
|
| Rate for Payer: Amerigroup Medicare |
$157.06
|
| Rate for Payer: Cash Price |
$276.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.17
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$155.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$197.38
|
| Rate for Payer: Medical Associates Commercial |
$259.17
|
| Rate for Payer: Medical Associates Managed Medicare |
$155.50
|
| Rate for Payer: Midlands Choice Commercial |
$241.89
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$200.29
|
| Rate for Payer: Partners Health Alliance Commercial |
$178.83
|
| Rate for Payer: United Healthcare Commercial |
$311.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$203.88
|
|
|
hydrocortisone/neomycin/polymyxin B otic 1%-0.35%-10000 units/mL Sus[VDMC]
|
Facility
|
IP
|
$345.56
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
14052150
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$241.89 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: Aetna of IA Commercial |
$311.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$311.00
|
| Rate for Payer: Cash Price |
$276.45
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$259.17
|
| Rate for Payer: Medical Associates Commercial |
$259.17
|
| Rate for Payer: Midlands Choice Commercial |
$241.89
|
| Rate for Payer: United Healthcare Commercial |
$311.00
|
|
|
hydrocortisone Top 2.5% Crm [VDMC]
|
Facility
|
IP
|
$15.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435050
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$13.64 |
| Rate for Payer: Aetna of IA Commercial |
$13.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.64
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.37
|
| Rate for Payer: Medical Associates Commercial |
$11.37
|
| Rate for Payer: Midlands Choice Commercial |
$10.61
|
| Rate for Payer: United Healthcare Commercial |
$13.64
|
|
|
hydrocortisone Top 2.5% Crm [VDMC]
|
Facility
|
OP
|
$15.16
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10435050
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$13.64 |
| Rate for Payer: Aetna of IA Commercial |
$13.64
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$13.64
|
| Rate for Payer: Aetna of IA Medicare |
$8.64
|
| Rate for Payer: Amerigroup Medicaid |
$8.74
|
| Rate for Payer: Amerigroup Medicare |
$6.89
|
| Rate for Payer: Cash Price |
$12.13
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$11.37
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.82
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8.66
|
| Rate for Payer: Medical Associates Commercial |
$11.37
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.82
|
| Rate for Payer: Midlands Choice Commercial |
$10.61
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$7.85
|
| Rate for Payer: United Healthcare Commercial |
$13.64
|
| Rate for Payer: United Healthcare Managed Medicare |
$8.94
|
|
|
Hydrocortisone Topical 1% Cream 28gm [VDMC]
|
Facility
|
OP
|
$12.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222328
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$11.45 |
| Rate for Payer: Aetna of IA Commercial |
$11.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.45
|
| Rate for Payer: Aetna of IA Medicare |
$7.25
|
| Rate for Payer: Amerigroup Medicaid |
$7.34
|
| Rate for Payer: Amerigroup Medicare |
$5.78
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.54
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$5.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$7.27
|
| Rate for Payer: Medical Associates Commercial |
$9.54
|
| Rate for Payer: Medical Associates Managed Medicare |
$5.72
|
| Rate for Payer: Midlands Choice Commercial |
$8.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$7.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$6.58
|
| Rate for Payer: United Healthcare Commercial |
$11.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.50
|
|
|
Hydrocortisone Topical 1% Cream 28gm [VDMC]
|
Facility
|
IP
|
$12.72
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222328
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$11.45 |
| Rate for Payer: Aetna of IA Commercial |
$11.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$11.45
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.54
|
| Rate for Payer: Medical Associates Commercial |
$9.54
|
| Rate for Payer: Midlands Choice Commercial |
$8.90
|
| Rate for Payer: United Healthcare Commercial |
$11.45
|
|
|
hydrocortisone topical 2.5% Oin [VDMC]
|
Facility
|
OP
|
$17.80
|
|
|
Service Code
|
NDC 00168-0146-30
|
| Hospital Charge Code |
13511301
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$16.02 |
| Rate for Payer: Aetna of IA Commercial |
$16.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.02
|
| Rate for Payer: Aetna of IA Medicare |
$10.15
|
| Rate for Payer: Amerigroup Medicaid |
$10.27
|
| Rate for Payer: Amerigroup Medicare |
$8.09
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.35
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.01
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.17
|
| Rate for Payer: Medical Associates Commercial |
$13.35
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.01
|
| Rate for Payer: Midlands Choice Commercial |
$12.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.21
|
| Rate for Payer: United Healthcare Commercial |
$16.02
|
| Rate for Payer: United Healthcare Managed Medicare |
$10.50
|
|
|
hydrocortisone topical 2.5% Oin [VDMC]
|
Facility
|
IP
|
$17.80
|
|
|
Service Code
|
NDC 00168-0146-30
|
| Hospital Charge Code |
13511301
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$16.02 |
| Rate for Payer: Aetna of IA Commercial |
$16.02
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.02
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$13.35
|
| Rate for Payer: Medical Associates Commercial |
$13.35
|
| Rate for Payer: Midlands Choice Commercial |
$12.46
|
| Rate for Payer: United Healthcare Commercial |
$16.02
|
|
|
HYDROmorphone 10 mg/mL Inj Sol [VDMC]
|
Facility
|
IP
|
$62.16
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10394654
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$43.51 |
| Max. Negotiated Rate |
$55.94 |
| Rate for Payer: Aetna of IA Commercial |
$55.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.94
|
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.62
|
| Rate for Payer: Medical Associates Commercial |
$46.62
|
| Rate for Payer: Midlands Choice Commercial |
$43.51
|
| Rate for Payer: United Healthcare Commercial |
$55.94
|
|
|
HYDROmorphone 10 mg/mL Inj Sol [VDMC]
|
Facility
|
OP
|
$62.16
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10394654
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$55.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$55.94
|
| Rate for Payer: Aetna of IA Medicare |
$35.43
|
| Rate for Payer: Amerigroup Medicaid |
$35.85
|
| Rate for Payer: Amerigroup Medicare |
$28.25
|
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Cash Price |
$49.72
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$46.62
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.97
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$35.50
|
| Rate for Payer: Medical Associates Commercial |
$46.62
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.97
|
| Rate for Payer: Midlands Choice Commercial |
$43.51
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$36.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$32.17
|
| Rate for Payer: United Healthcare Commercial |
$55.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$36.67
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
HYDROmorphone 1 mg/mL syringe [VDMC]
|
Facility
|
OP
|
$47.14
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
15383162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$42.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.43
|
| Rate for Payer: Aetna of IA Medicare |
$26.87
|
| Rate for Payer: Amerigroup Medicaid |
$27.19
|
| Rate for Payer: Amerigroup Medicare |
$21.43
|
| Rate for Payer: Cash Price |
$37.71
|
| Rate for Payer: Cash Price |
$37.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.21
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$26.93
|
| Rate for Payer: Medical Associates Commercial |
$35.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.21
|
| Rate for Payer: Midlands Choice Commercial |
$33.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$24.39
|
| Rate for Payer: United Healthcare Commercial |
$42.43
|
| Rate for Payer: United Healthcare Managed Medicare |
$27.81
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
HYDROmorphone 1 mg/mL syringe [VDMC]
|
Facility
|
IP
|
$47.14
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
15383162
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$42.43 |
| Rate for Payer: Aetna of IA Commercial |
$42.43
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$42.43
|
| Rate for Payer: Cash Price |
$37.71
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$35.36
|
| Rate for Payer: Medical Associates Commercial |
$35.36
|
| Rate for Payer: Midlands Choice Commercial |
$33.00
|
| Rate for Payer: United Healthcare Commercial |
$42.43
|
|
|
HYDROmorphone 2 mg/mL Sol 20mL [VDMC]
|
Facility
|
IP
|
$108.56
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
11717471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$75.99 |
| Max. Negotiated Rate |
$97.70 |
| Rate for Payer: Aetna of IA Commercial |
$97.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.70
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.42
|
| Rate for Payer: Medical Associates Commercial |
$81.42
|
| Rate for Payer: Midlands Choice Commercial |
$75.99
|
| Rate for Payer: United Healthcare Commercial |
$97.70
|
|
|
HYDROmorphone 2 mg/mL Sol 20mL [VDMC]
|
Facility
|
OP
|
$108.56
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
11717471
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$48.85 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$97.70
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$97.70
|
| Rate for Payer: Aetna of IA Medicare |
$61.88
|
| Rate for Payer: Amerigroup Medicaid |
$62.62
|
| Rate for Payer: Amerigroup Medicare |
$49.34
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Cash Price |
$86.85
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$81.42
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$48.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$62.01
|
| Rate for Payer: Medical Associates Commercial |
$81.42
|
| Rate for Payer: Medical Associates Managed Medicare |
$48.85
|
| Rate for Payer: Midlands Choice Commercial |
$75.99
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$62.92
|
| Rate for Payer: Partners Health Alliance Commercial |
$56.18
|
| Rate for Payer: United Healthcare Commercial |
$97.70
|
| Rate for Payer: United Healthcare Managed Medicare |
$64.05
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
HYDROmorphone 2 mg/mL syringe 1mL [VDMC]
|
Facility
|
OP
|
$48.65
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10394794
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$21.89 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$43.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$43.78
|
| Rate for Payer: Aetna of IA Medicare |
$27.73
|
| Rate for Payer: Amerigroup Medicaid |
$28.06
|
| Rate for Payer: Amerigroup Medicare |
$22.11
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.49
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$21.89
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.79
|
| Rate for Payer: Medical Associates Commercial |
$36.49
|
| Rate for Payer: Medical Associates Managed Medicare |
$21.89
|
| Rate for Payer: Midlands Choice Commercial |
$34.05
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.18
|
| Rate for Payer: United Healthcare Commercial |
$43.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.70
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
HYDROmorphone 2 mg/mL syringe 1mL [VDMC]
|
Facility
|
IP
|
$48.65
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
10394794
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.05 |
| Max. Negotiated Rate |
$43.78 |
| Rate for Payer: Aetna of IA Commercial |
$43.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$43.78
|
| Rate for Payer: Cash Price |
$38.92
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.49
|
| Rate for Payer: Medical Associates Commercial |
$36.49
|
| Rate for Payer: Midlands Choice Commercial |
$34.05
|
| Rate for Payer: United Healthcare Commercial |
$43.78
|
|
|
HYDROmorphone 2 mg/mL vial [VDMC]
|
Facility
|
IP
|
$45.31
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
15701801
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$31.71 |
| Max. Negotiated Rate |
$40.78 |
| Rate for Payer: Aetna of IA Commercial |
$40.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.78
|
| Rate for Payer: Cash Price |
$36.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.98
|
| Rate for Payer: Medical Associates Commercial |
$33.98
|
| Rate for Payer: Midlands Choice Commercial |
$31.71
|
| Rate for Payer: United Healthcare Commercial |
$40.78
|
|
|
HYDROmorphone 2 mg/mL vial [VDMC]
|
Facility
|
OP
|
$45.31
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
15701801
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$40.78
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$40.78
|
| Rate for Payer: Aetna of IA Medicare |
$25.82
|
| Rate for Payer: Amerigroup Medicaid |
$26.13
|
| Rate for Payer: Amerigroup Medicare |
$20.59
|
| Rate for Payer: Cash Price |
$36.24
|
| Rate for Payer: Cash Price |
$36.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$33.98
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$20.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.88
|
| Rate for Payer: Medical Associates Commercial |
$33.98
|
| Rate for Payer: Medical Associates Managed Medicare |
$20.39
|
| Rate for Payer: Midlands Choice Commercial |
$31.71
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$26.26
|
| Rate for Payer: Partners Health Alliance Commercial |
$23.45
|
| Rate for Payer: United Healthcare Commercial |
$40.78
|
| Rate for Payer: United Healthcare Managed Medicare |
$26.73
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
