|
mepolizumab 100 mg/mL Syringe PFS [VDMC]
|
Facility
|
OP
|
$7,262.78
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
23618580
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3,629.94 |
| Max. Negotiated Rate |
$6,536.50 |
| Rate for Payer: Aetna of IA Commercial |
$6,536.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6,536.50
|
| Rate for Payer: Aetna of IA Medicare |
$4,139.78
|
| Rate for Payer: Amerigroup Medicaid |
$3,665.53
|
| Rate for Payer: Amerigroup Medicare |
$3,667.70
|
| Rate for Payer: Cash Price |
$5,810.22
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5,447.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3,631.39
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3,629.94
|
| Rate for Payer: Medical Associates Commercial |
$5,447.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$3,631.39
|
| Rate for Payer: Midlands Choice Commercial |
$5,083.95
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3,685.86
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3,683.68
|
| Rate for Payer: Oscar Health of IA Commercial |
$5,447.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$5,447.08
|
| Rate for Payer: United Healthcare Commercial |
$6,536.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$4,285.04
|
|
|
mercaptopurine 50 mg Tab [VDMC]
|
Facility
|
IP
|
$37.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403238
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Aetna of IA Commercial |
$33.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.52
|
| Rate for Payer: Cash Price |
$29.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.93
|
| Rate for Payer: Medical Associates Commercial |
$27.93
|
| Rate for Payer: Midlands Choice Commercial |
$26.07
|
| Rate for Payer: United Healthcare Commercial |
$33.52
|
|
|
mercaptopurine 50 mg Tab [VDMC]
|
Facility
|
OP
|
$37.24
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403238
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$18.61 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Aetna of IA Commercial |
$33.52
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$33.52
|
| Rate for Payer: Aetna of IA Medicare |
$21.23
|
| Rate for Payer: Amerigroup Medicaid |
$18.80
|
| Rate for Payer: Amerigroup Medicare |
$18.81
|
| Rate for Payer: Cash Price |
$29.79
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$27.93
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$18.62
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$18.61
|
| Rate for Payer: Medical Associates Commercial |
$27.93
|
| Rate for Payer: Medical Associates Managed Medicare |
$18.62
|
| Rate for Payer: Midlands Choice Commercial |
$26.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$18.90
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$18.89
|
| Rate for Payer: Oscar Health of IA Commercial |
$27.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$27.93
|
| Rate for Payer: United Healthcare Commercial |
$33.52
|
| Rate for Payer: United Healthcare Managed Medicare |
$21.97
|
|
|
meropenem 500 mg IV Inj SDV [VDMC]
|
Facility
|
IP
|
$27.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
10403376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.57 |
| Max. Negotiated Rate |
$25.16 |
| Rate for Payer: Aetna of IA Commercial |
$25.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.16
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.97
|
| Rate for Payer: Medical Associates Commercial |
$20.97
|
| Rate for Payer: Midlands Choice Commercial |
$19.57
|
| Rate for Payer: United Healthcare Commercial |
$25.16
|
|
|
meropenem 500 mg IV Inj SDV [VDMC]
|
Facility
|
OP
|
$27.96
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
10403376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$13.97 |
| Max. Negotiated Rate |
$25.16 |
| Rate for Payer: Aetna of IA Commercial |
$25.16
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$25.16
|
| Rate for Payer: Aetna of IA Medicare |
$15.94
|
| Rate for Payer: Amerigroup Medicaid |
$14.11
|
| Rate for Payer: Amerigroup Medicare |
$14.12
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.97
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$13.98
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$13.97
|
| Rate for Payer: Medical Associates Commercial |
$20.97
|
| Rate for Payer: Medical Associates Managed Medicare |
$13.98
|
| Rate for Payer: Midlands Choice Commercial |
$19.57
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.19
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$14.18
|
| Rate for Payer: Oscar Health of IA Commercial |
$20.97
|
| Rate for Payer: Partners Health Alliance Commercial |
$20.97
|
| Rate for Payer: United Healthcare Commercial |
$25.16
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.50
|
|
|
mesalamine 250 mg ERCap [VDMC]
|
Facility
|
IP
|
$12.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Aetna of IA Commercial |
$10.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.90
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.08
|
| Rate for Payer: Medical Associates Commercial |
$9.08
|
| Rate for Payer: Midlands Choice Commercial |
$8.48
|
| Rate for Payer: United Healthcare Commercial |
$10.90
|
|
|
mesalamine 250 mg ERCap [VDMC]
|
Facility
|
OP
|
$12.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403514
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$10.90 |
| Rate for Payer: Aetna of IA Commercial |
$10.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$10.90
|
| Rate for Payer: Aetna of IA Medicare |
$6.90
|
| Rate for Payer: Amerigroup Medicaid |
$6.11
|
| Rate for Payer: Amerigroup Medicare |
$6.12
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$9.08
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$6.06
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$6.05
|
| Rate for Payer: Medical Associates Commercial |
$9.08
|
| Rate for Payer: Medical Associates Managed Medicare |
$6.06
|
| Rate for Payer: Midlands Choice Commercial |
$8.48
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$6.15
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$6.14
|
| Rate for Payer: Oscar Health of IA Commercial |
$9.08
|
| Rate for Payer: Partners Health Alliance Commercial |
$9.08
|
| Rate for Payer: United Healthcare Commercial |
$10.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$7.14
|
|
|
mesalamine 400 mg Cap DR [VDMC]
|
Facility
|
IP
|
$7.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403583
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: Aetna of IA Commercial |
$6.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.46
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.38
|
| Rate for Payer: Medical Associates Commercial |
$5.38
|
| Rate for Payer: Midlands Choice Commercial |
$5.03
|
| Rate for Payer: United Healthcare Commercial |
$6.46
|
|
|
mesalamine 400 mg Cap DR [VDMC]
|
Facility
|
OP
|
$7.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403583
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$3.59 |
| Max. Negotiated Rate |
$6.46 |
| Rate for Payer: Aetna of IA Commercial |
$6.46
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$6.46
|
| Rate for Payer: Aetna of IA Medicare |
$4.09
|
| Rate for Payer: Amerigroup Medicaid |
$3.62
|
| Rate for Payer: Amerigroup Medicare |
$3.63
|
| Rate for Payer: Cash Price |
$5.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$5.38
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$3.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$3.59
|
| Rate for Payer: Medical Associates Commercial |
$5.38
|
| Rate for Payer: Medical Associates Managed Medicare |
$3.59
|
| Rate for Payer: Midlands Choice Commercial |
$5.03
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$3.64
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$3.64
|
| Rate for Payer: Oscar Health of IA Commercial |
$5.38
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.38
|
| Rate for Payer: United Healthcare Commercial |
$6.46
|
| Rate for Payer: United Healthcare Managed Medicare |
$4.24
|
|
|
MESH COMPOSITE PARIETEX 10X8
|
Facility
|
IP
|
$1,554.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8047039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,087.80 |
| Max. Negotiated Rate |
$1,398.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,398.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,398.60
|
| Rate for Payer: Cash Price |
$1,243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,165.50
|
| Rate for Payer: Medical Associates Commercial |
$1,165.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,087.80
|
| Rate for Payer: United Healthcare Commercial |
$1,398.60
|
|
|
MESH COMPOSITE PARIETEX 10X8
|
Facility
|
OP
|
$1,554.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8047039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$776.69 |
| Max. Negotiated Rate |
$1,398.60 |
| Rate for Payer: Aetna of IA Commercial |
$1,398.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,398.60
|
| Rate for Payer: Aetna of IA Medicare |
$885.78
|
| Rate for Payer: Amerigroup Medicaid |
$784.30
|
| Rate for Payer: Amerigroup Medicare |
$784.77
|
| Rate for Payer: Cash Price |
$1,243.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,165.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$777.00
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$776.69
|
| Rate for Payer: Medical Associates Commercial |
$1,165.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$777.00
|
| Rate for Payer: Midlands Choice Commercial |
$1,087.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$788.66
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$788.19
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,165.50
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,165.50
|
| Rate for Payer: United Healthcare Commercial |
$1,398.60
|
| Rate for Payer: United Healthcare Managed Medicare |
$916.86
|
|
|
MESH COMPOSITE PARIETEX 8X6
|
Facility
|
OP
|
$1,497.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8046389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.20 |
| Max. Negotiated Rate |
$1,347.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,347.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,347.30
|
| Rate for Payer: Aetna of IA Medicare |
$853.29
|
| Rate for Payer: Amerigroup Medicaid |
$755.54
|
| Rate for Payer: Amerigroup Medicare |
$755.98
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,122.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$748.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$748.20
|
| Rate for Payer: Medical Associates Commercial |
$1,122.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$748.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,047.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$759.73
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$759.28
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,122.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,122.75
|
| Rate for Payer: United Healthcare Commercial |
$1,347.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$883.23
|
|
|
MESH COMPOSITE PARIETEX 8X6
|
Facility
|
IP
|
$1,497.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8046389
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.90 |
| Max. Negotiated Rate |
$1,347.30 |
| Rate for Payer: Aetna of IA Commercial |
$1,347.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,347.30
|
| Rate for Payer: Cash Price |
$1,197.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,122.75
|
| Rate for Payer: Medical Associates Commercial |
$1,122.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,047.90
|
| Rate for Payer: United Healthcare Commercial |
$1,347.30
|
|
|
MESH VENTRALIGHT ST 11CM
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8773703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$696.50 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Aetna of IA Commercial |
$895.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$895.50
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$746.25
|
| Rate for Payer: Medical Associates Commercial |
$746.25
|
| Rate for Payer: Midlands Choice Commercial |
$696.50
|
| Rate for Payer: United Healthcare Commercial |
$895.50
|
|
|
MESH VENTRALIGHT ST 11CM
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8773703
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$497.30 |
| Max. Negotiated Rate |
$895.50 |
| Rate for Payer: Aetna of IA Commercial |
$895.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$895.50
|
| Rate for Payer: Aetna of IA Medicare |
$567.15
|
| Rate for Payer: Amerigroup Medicaid |
$502.18
|
| Rate for Payer: Amerigroup Medicare |
$502.48
|
| Rate for Payer: Cash Price |
$796.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$746.25
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$497.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$497.30
|
| Rate for Payer: Medical Associates Commercial |
$746.25
|
| Rate for Payer: Medical Associates Managed Medicare |
$497.50
|
| Rate for Payer: Midlands Choice Commercial |
$696.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$504.96
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$504.66
|
| Rate for Payer: Oscar Health of IA Commercial |
$746.25
|
| Rate for Payer: Partners Health Alliance Commercial |
$746.25
|
| Rate for Payer: United Healthcare Commercial |
$895.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$587.05
|
|
|
MESH VENTRALIGHT ST 6X8
|
Facility
|
OP
|
$1,805.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8711059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$902.14 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,624.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,624.50
|
| Rate for Payer: Aetna of IA Medicare |
$1,028.85
|
| Rate for Payer: Amerigroup Medicaid |
$910.98
|
| Rate for Payer: Amerigroup Medicare |
$911.52
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,353.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$902.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$902.14
|
| Rate for Payer: Medical Associates Commercial |
$1,353.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$902.50
|
| Rate for Payer: Midlands Choice Commercial |
$1,263.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$916.04
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$915.50
|
| Rate for Payer: Oscar Health of IA Commercial |
$1,353.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$1,353.75
|
| Rate for Payer: United Healthcare Commercial |
$1,624.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$1,064.95
|
|
|
MESH VENTRALIGHT ST 6X8
|
Facility
|
IP
|
$1,805.00
|
|
|
Service Code
|
CPT C1781
|
| Hospital Charge Code |
8711059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,263.50 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna of IA Commercial |
$1,624.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,624.50
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1,353.75
|
| Rate for Payer: Medical Associates Commercial |
$1,353.75
|
| Rate for Payer: Midlands Choice Commercial |
$1,263.50
|
| Rate for Payer: United Healthcare Commercial |
$1,624.50
|
|
|
Mesna 100 mg/mL 10 ml MDV inj [VDMC]
|
Facility
|
OP
|
$50.92
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
10403652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Aetna of IA Commercial |
$45.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.83
|
| Rate for Payer: Aetna of IA Medicare |
$29.02
|
| Rate for Payer: Amerigroup Medicaid |
$25.70
|
| Rate for Payer: Amerigroup Medicare |
$25.71
|
| Rate for Payer: Cash Price |
$40.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.19
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.45
|
| Rate for Payer: Medical Associates Commercial |
$38.19
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.46
|
| Rate for Payer: Midlands Choice Commercial |
$35.64
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.84
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$25.83
|
| Rate for Payer: Oscar Health of IA Commercial |
$38.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$38.19
|
| Rate for Payer: United Healthcare Commercial |
$45.83
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.04
|
|
|
Mesna 100 mg/mL 10 ml MDV inj [VDMC]
|
Facility
|
IP
|
$50.92
|
|
|
Service Code
|
HCPCS J9209
|
| Hospital Charge Code |
10403652
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$45.83 |
| Rate for Payer: Aetna of IA Commercial |
$45.83
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.83
|
| Rate for Payer: Cash Price |
$40.74
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.19
|
| Rate for Payer: Medical Associates Commercial |
$38.19
|
| Rate for Payer: Midlands Choice Commercial |
$35.64
|
| Rate for Payer: United Healthcare Commercial |
$45.83
|
|
|
metaxalone 800 mg Tab [VDMC]
|
Facility
|
OP
|
$3.21
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403721
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna of IA Commercial |
$2.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.89
|
| Rate for Payer: Aetna of IA Medicare |
$1.83
|
| Rate for Payer: Amerigroup Medicaid |
$1.62
|
| Rate for Payer: Amerigroup Medicare |
$1.62
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.41
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.60
|
| Rate for Payer: Medical Associates Commercial |
$2.41
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.60
|
| Rate for Payer: Midlands Choice Commercial |
$2.25
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.63
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.41
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.41
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.89
|
|
|
metaxalone 800 mg Tab [VDMC]
|
Facility
|
IP
|
$3.21
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403721
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.89 |
| Rate for Payer: Aetna of IA Commercial |
$2.89
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.89
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.41
|
| Rate for Payer: Medical Associates Commercial |
$2.41
|
| Rate for Payer: Midlands Choice Commercial |
$2.25
|
| Rate for Payer: United Healthcare Commercial |
$2.89
|
|
|
metFORMIN 500 mg 24 HR ER Tab [VDMC]
|
Facility
|
IP
|
$2.19
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403792
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Aetna of IA Commercial |
$1.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.97
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.64
|
| Rate for Payer: Medical Associates Commercial |
$1.64
|
| Rate for Payer: Midlands Choice Commercial |
$1.53
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
|
|
metFORMIN 500 mg 24 HR ER Tab [VDMC]
|
Facility
|
OP
|
$2.19
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403792
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Aetna of IA Commercial |
$1.97
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.97
|
| Rate for Payer: Aetna of IA Medicare |
$1.25
|
| Rate for Payer: Amerigroup Medicaid |
$1.11
|
| Rate for Payer: Amerigroup Medicare |
$1.11
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.10
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.09
|
| Rate for Payer: Medical Associates Commercial |
$1.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.10
|
| Rate for Payer: Midlands Choice Commercial |
$1.53
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.11
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.11
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.64
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.29
|
|
|
metFORMIN 500 mg Tab [VDMC]
|
Facility
|
IP
|
$1.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna of IA Commercial |
$1.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.33
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.11
|
| Rate for Payer: Medical Associates Commercial |
$1.11
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
|
|
metFORMIN 500 mg Tab [VDMC]
|
Facility
|
OP
|
$1.48
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10403861
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.33 |
| Rate for Payer: Aetna of IA Commercial |
$1.33
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.33
|
| Rate for Payer: Aetna of IA Medicare |
$0.84
|
| Rate for Payer: Amerigroup Medicaid |
$0.75
|
| Rate for Payer: Amerigroup Medicare |
$0.75
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.11
|
| 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 |
$0.74
|
| Rate for Payer: Medical Associates Commercial |
$1.11
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.74
|
| Rate for Payer: Midlands Choice Commercial |
$1.04
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.75
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.75
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.11
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.87
|
|
