|
meclizine 25 mg Tab [VDMC]
|
Facility
|
OP
|
$2.39
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402412
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.15 |
| Rate for Payer: Aetna of IA Commercial |
$2.15
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.15
|
| Rate for Payer: Aetna of IA Medicare |
$1.36
|
| Rate for Payer: Amerigroup Medicaid |
$1.38
|
| Rate for Payer: Amerigroup Medicare |
$1.09
|
| Rate for Payer: Cash Price |
$1.91
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.37
|
| Rate for Payer: Medical Associates Commercial |
$1.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.08
|
| Rate for Payer: Midlands Choice Commercial |
$1.67
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.39
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.24
|
| Rate for Payer: United Healthcare Commercial |
$2.15
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.41
|
|
|
medroxyPROGESTERone 10 mg Tab [VDMC]
|
Facility
|
IP
|
$1.57
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402481
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of IA Commercial |
$1.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.42
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.18
|
| Rate for Payer: Medical Associates Commercial |
$1.18
|
| Rate for Payer: Midlands Choice Commercial |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
|
|
medroxyPROGESTERone 10 mg Tab [VDMC]
|
Facility
|
OP
|
$1.57
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402481
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.42 |
| Rate for Payer: Aetna of IA Commercial |
$1.42
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.42
|
| Rate for Payer: Aetna of IA Medicare |
$0.90
|
| Rate for Payer: Amerigroup Medicaid |
$0.91
|
| Rate for Payer: Amerigroup Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.26
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.18
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.71
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.90
|
| Rate for Payer: Medical Associates Commercial |
$1.18
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.71
|
| Rate for Payer: Midlands Choice Commercial |
$1.10
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.91
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$1.42
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.93
|
|
|
medroxyPROGESTERone 150 mg/mL IM Susp SDV [VDMC]
|
Facility
|
OP
|
$146.55
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
10402550
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$65.95 |
| Max. Negotiated Rate |
$131.89 |
| Rate for Payer: Aetna of IA Commercial |
$131.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.89
|
| Rate for Payer: Aetna of IA Medicare |
$83.53
|
| Rate for Payer: Amerigroup Medicaid |
$84.53
|
| Rate for Payer: Amerigroup Medicare |
$66.60
|
| Rate for Payer: Cash Price |
$117.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.91
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$65.95
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$83.71
|
| Rate for Payer: Medical Associates Commercial |
$109.91
|
| Rate for Payer: Medical Associates Managed Medicare |
$65.95
|
| Rate for Payer: Midlands Choice Commercial |
$102.58
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$84.94
|
| Rate for Payer: Partners Health Alliance Commercial |
$75.84
|
| Rate for Payer: United Healthcare Commercial |
$131.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$86.46
|
|
|
medroxyPROGESTERone 150 mg/mL IM Susp SDV [VDMC]
|
Facility
|
IP
|
$146.55
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
10402550
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$102.58 |
| Max. Negotiated Rate |
$131.89 |
| Rate for Payer: Aetna of IA Commercial |
$131.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$131.89
|
| Rate for Payer: Cash Price |
$117.24
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$109.91
|
| Rate for Payer: Medical Associates Commercial |
$109.91
|
| Rate for Payer: Midlands Choice Commercial |
$102.58
|
| Rate for Payer: United Healthcare Commercial |
$131.89
|
|
|
medroxyPROGESTERone 2.5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402617
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of IA Commercial |
$1.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.23
|
| Rate for Payer: Aetna of IA Medicare |
$0.78
|
| Rate for Payer: Amerigroup Medicaid |
$0.79
|
| Rate for Payer: Amerigroup Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.78
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.62
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.81
|
|
|
medroxyPROGESTERone 2.5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402617
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of IA Commercial |
$1.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.23
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
|
|
Med/Surg
|
Facility
|
IP
|
$1,400.00
|
|
| Hospital Charge Code |
4903043
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$980.00 |
| Max. Negotiated Rate |
$2,580.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,260.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,260.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,258.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Cash Price |
$1,120.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,050.00
|
| Rate for Payer: Medical Associates Commercial |
$1,050.00
|
| Rate for Payer: Midlands Choice Commercial |
$980.00
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,580.60
|
| Rate for Payer: United Healthcare Commercial |
$1,260.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,306.00
|
|
|
Med/Surg: SNF
|
Facility
|
IP
|
$1,000.00
|
|
| Hospital Charge Code |
4903043
|
|
Hospital Revenue Code
|
119
|
| Min. Negotiated Rate |
$700.00 |
| Max. Negotiated Rate |
$2,580.60 |
| Rate for Payer: Aetna of IA Commercial |
$900.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$900.00
|
| Rate for Payer: Aetna of IA Medicare |
$2,258.00
|
| Rate for Payer: Amerigroup Medicaid |
$1,846.10
|
| Rate for Payer: Amerigroup Medicare |
$2,081.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$750.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2,081.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1,828.18
|
| Rate for Payer: Medical Associates Commercial |
$750.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$2,081.00
|
| Rate for Payer: Midlands Choice Commercial |
$700.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1,855.06
|
| Rate for Payer: Partners Health Alliance Commercial |
$2,580.60
|
| Rate for Payer: United Healthcare Commercial |
$900.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,306.00
|
|
|
megestrol 40 mg/mL 10ml cup Sus [VDMC]
|
Facility
|
IP
|
$18.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11517858
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$16.81 |
| Rate for Payer: Aetna of IA Commercial |
$16.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.81
|
| Rate for Payer: Cash Price |
$14.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.01
|
| Rate for Payer: Medical Associates Commercial |
$14.01
|
| Rate for Payer: Midlands Choice Commercial |
$13.08
|
| Rate for Payer: United Healthcare Commercial |
$16.81
|
|
|
megestrol 40 mg/mL 10ml cup Sus [VDMC]
|
Facility
|
OP
|
$18.68
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11517858
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$16.81 |
| Rate for Payer: Aetna of IA Commercial |
$16.81
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$16.81
|
| Rate for Payer: Aetna of IA Medicare |
$10.65
|
| Rate for Payer: Amerigroup Medicaid |
$10.77
|
| Rate for Payer: Amerigroup Medicare |
$8.49
|
| Rate for Payer: Cash Price |
$14.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$14.01
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$8.41
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$10.67
|
| Rate for Payer: Medical Associates Commercial |
$14.01
|
| Rate for Payer: Medical Associates Managed Medicare |
$8.41
|
| Rate for Payer: Midlands Choice Commercial |
$13.08
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$10.83
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.67
|
| Rate for Payer: United Healthcare Commercial |
$16.81
|
| Rate for Payer: United Healthcare Managed Medicare |
$11.02
|
|
|
megestrol 40 mg Tab [VDMC]
|
Facility
|
OP
|
$1.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402686
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of IA Commercial |
$1.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.47
|
| Rate for Payer: Aetna of IA Medicare |
$0.93
|
| Rate for Payer: Amerigroup Medicaid |
$0.94
|
| Rate for Payer: Amerigroup Medicare |
$0.74
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.23
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.74
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.93
|
| Rate for Payer: Medical Associates Commercial |
$1.23
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.74
|
| Rate for Payer: Midlands Choice Commercial |
$1.14
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.96
|
|
|
megestrol 40 mg Tab [VDMC]
|
Facility
|
IP
|
$1.63
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402686
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of IA Commercial |
$1.47
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.47
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.23
|
| Rate for Payer: Medical Associates Commercial |
$1.23
|
| Rate for Payer: Midlands Choice Commercial |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
|
|
melatonin 3 mg Tab [VDMC]
|
Facility
|
IP
|
$1.45
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402826
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.09
|
| Rate for Payer: Medical Associates Commercial |
$1.09
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
|
|
melatonin 3 mg Tab [VDMC]
|
Facility
|
OP
|
$1.45
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402826
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.30 |
| Rate for Payer: Aetna of IA Commercial |
$1.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.30
|
| Rate for Payer: Aetna of IA Medicare |
$0.83
|
| Rate for Payer: Amerigroup Medicaid |
$0.83
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.09
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$1.09
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.65
|
| Rate for Payer: Midlands Choice Commercial |
$1.01
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$1.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.85
|
|
|
meloxicam 30 mg/mL 1ml DSP SDV [VDMC]
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS J1738
|
| Hospital Charge Code |
22582257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$161.55 |
| Max. Negotiated Rate |
$323.10 |
| Rate for Payer: Aetna of IA Commercial |
$323.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$323.10
|
| Rate for Payer: Aetna of IA Medicare |
$204.63
|
| Rate for Payer: Amerigroup Medicaid |
$207.07
|
| Rate for Payer: Amerigroup Medicare |
$163.17
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$269.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$161.55
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$205.06
|
| Rate for Payer: Medical Associates Commercial |
$269.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$161.55
|
| Rate for Payer: Midlands Choice Commercial |
$251.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$208.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$185.78
|
| Rate for Payer: United Healthcare Commercial |
$323.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$211.81
|
|
|
meloxicam 30 mg/mL 1ml DSP SDV [VDMC]
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS J1738
|
| Hospital Charge Code |
22582257
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$251.30 |
| Max. Negotiated Rate |
$323.10 |
| Rate for Payer: Aetna of IA Commercial |
$323.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$323.10
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$269.25
|
| Rate for Payer: Medical Associates Commercial |
$269.25
|
| Rate for Payer: Midlands Choice Commercial |
$251.30
|
| Rate for Payer: United Healthcare Commercial |
$323.10
|
|
|
meloxicam 7.5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402895
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of IA Commercial |
$1.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.23
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
|
|
meloxicam 7.5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402895
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of IA Commercial |
$1.23
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.23
|
| Rate for Payer: Aetna of IA Medicare |
$0.78
|
| Rate for Payer: Amerigroup Medicaid |
$0.79
|
| Rate for Payer: Amerigroup Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$1.10
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.03
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.78
|
| Rate for Payer: Medical Associates Commercial |
$1.03
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.62
|
| Rate for Payer: Midlands Choice Commercial |
$0.96
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.80
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.71
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.81
|
|
|
memantine 10 mg Tab [VDMC]
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.42 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of IA Commercial |
$1.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.82
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.52
|
| Rate for Payer: Medical Associates Commercial |
$1.52
|
| Rate for Payer: Midlands Choice Commercial |
$1.42
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
|
|
memantine 10 mg Tab [VDMC]
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10402966
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna of IA Commercial |
$1.82
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.82
|
| Rate for Payer: Aetna of IA Medicare |
$1.15
|
| Rate for Payer: Amerigroup Medicaid |
$1.17
|
| Rate for Payer: Amerigroup Medicare |
$0.92
|
| Rate for Payer: Cash Price |
$1.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.52
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.91
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.16
|
| Rate for Payer: Medical Associates Commercial |
$1.52
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.91
|
| Rate for Payer: Midlands Choice Commercial |
$1.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.17
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.05
|
| Rate for Payer: United Healthcare Commercial |
$1.82
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.19
|
|
|
meningococcal conjugate vaccine - Pow[VDMC]
|
Facility
|
IP
|
$220.93
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
23286480
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$154.65 |
| Max. Negotiated Rate |
$198.84 |
| Rate for Payer: Aetna of IA Commercial |
$198.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.84
|
| Rate for Payer: Cash Price |
$176.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.70
|
| Rate for Payer: Medical Associates Commercial |
$165.70
|
| Rate for Payer: Midlands Choice Commercial |
$154.65
|
| Rate for Payer: United Healthcare Commercial |
$198.84
|
|
|
meningococcal conjugate vaccine - Pow[VDMC]
|
Facility
|
OP
|
$220.93
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
23286480
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$99.42 |
| Max. Negotiated Rate |
$198.84 |
| Rate for Payer: Aetna of IA Commercial |
$198.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$198.84
|
| Rate for Payer: Aetna of IA Medicare |
$125.93
|
| Rate for Payer: Amerigroup Medicaid |
$127.43
|
| Rate for Payer: Amerigroup Medicare |
$100.41
|
| Rate for Payer: Cash Price |
$176.75
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$165.70
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$99.42
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$126.20
|
| Rate for Payer: Medical Associates Commercial |
$165.70
|
| Rate for Payer: Medical Associates Managed Medicare |
$99.42
|
| Rate for Payer: Midlands Choice Commercial |
$154.65
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$128.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$114.33
|
| Rate for Payer: United Healthcare Commercial |
$198.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$130.35
|
|
|
meningococcal group B vaccine recombinant, OMV, adjuvanted Sus 0.5ml SDS [VDMC]
|
Facility
|
OP
|
$329.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
20550418
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$148.13 |
| Max. Negotiated Rate |
$296.25 |
| Rate for Payer: Aetna of IA Commercial |
$296.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$296.25
|
| Rate for Payer: Aetna of IA Medicare |
$187.63
|
| Rate for Payer: Amerigroup Medicaid |
$189.86
|
| Rate for Payer: Amerigroup Medicare |
$149.61
|
| Rate for Payer: Cash Price |
$263.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$246.88
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$148.13
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$188.02
|
| Rate for Payer: Medical Associates Commercial |
$246.88
|
| Rate for Payer: Medical Associates Managed Medicare |
$148.13
|
| Rate for Payer: Midlands Choice Commercial |
$230.42
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$190.79
|
| Rate for Payer: Partners Health Alliance Commercial |
$170.34
|
| Rate for Payer: United Healthcare Commercial |
$296.25
|
| Rate for Payer: United Healthcare Managed Medicare |
$194.21
|
|
|
meningococcal group B vaccine recombinant, OMV, adjuvanted Sus 0.5ml SDS [VDMC]
|
Facility
|
IP
|
$329.17
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
20550418
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$230.42 |
| Max. Negotiated Rate |
$296.25 |
| Rate for Payer: Aetna of IA Commercial |
$296.25
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$296.25
|
| Rate for Payer: Cash Price |
$263.33
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$246.88
|
| Rate for Payer: Medical Associates Commercial |
$246.88
|
| Rate for Payer: Midlands Choice Commercial |
$230.42
|
| Rate for Payer: United Healthcare Commercial |
$296.25
|
|
