|
methadone 5 mg Tab[VDMC]
|
Facility
|
IP
|
$4.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11512126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of IA Commercial |
$3.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.75
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.13
|
| Rate for Payer: Medical Associates Commercial |
$3.13
|
| Rate for Payer: Midlands Choice Commercial |
$2.92
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
|
|
methadone 5 mg Tab[VDMC]
|
Facility
|
OP
|
$4.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11512126
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$3.75 |
| Rate for Payer: Aetna of IA Commercial |
$3.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$3.75
|
| Rate for Payer: Aetna of IA Medicare |
$2.38
|
| Rate for Payer: Amerigroup Medicaid |
$2.10
|
| Rate for Payer: Amerigroup Medicare |
$2.11
|
| Rate for Payer: Cash Price |
$3.34
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$3.13
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$2.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$2.08
|
| Rate for Payer: Medical Associates Commercial |
$3.13
|
| Rate for Payer: Medical Associates Managed Medicare |
$2.08
|
| Rate for Payer: Midlands Choice Commercial |
$2.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$2.12
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$2.12
|
| Rate for Payer: Oscar Health of IA Commercial |
$3.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$3.13
|
| Rate for Payer: United Healthcare Commercial |
$3.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$2.46
|
|
|
methimazole 5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404074
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of IA Commercial |
$1.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.73
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.44
|
| Rate for Payer: Medical Associates Commercial |
$1.44
|
| Rate for Payer: Midlands Choice Commercial |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
|
|
methimazole 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404074
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.96 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Aetna of IA Commercial |
$1.73
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.73
|
| Rate for Payer: Aetna of IA Medicare |
$1.09
|
| Rate for Payer: Amerigroup Medicaid |
$0.97
|
| Rate for Payer: Amerigroup Medicare |
$0.97
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.96
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.96
|
| Rate for Payer: Medical Associates Commercial |
$1.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.96
|
| Rate for Payer: Midlands Choice Commercial |
$1.34
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.97
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$0.97
|
| Rate for Payer: Oscar Health of IA Commercial |
$1.44
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$1.73
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.13
|
|
|
methocarbamol 500 mg Tab [VDMC]
|
Facility
|
IP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404145
|
|
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
|
|
|
methocarbamol 500 mg Tab [VDMC]
|
Facility
|
OP
|
$1.17
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404145
|
|
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
|
|
|
methotrexate 25 mg/mL 2 ML PF SDV [VDMC]
|
Facility
|
IP
|
$58.08
|
|
|
Service Code
|
HCPCS J9250
|
| Hospital Charge Code |
12477553
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.66 |
| Max. Negotiated Rate |
$52.27 |
| Rate for Payer: Aetna of IA Commercial |
$52.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.27
|
| Rate for Payer: Cash Price |
$46.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.56
|
| Rate for Payer: Medical Associates Commercial |
$43.56
|
| Rate for Payer: Midlands Choice Commercial |
$40.66
|
| Rate for Payer: United Healthcare Commercial |
$52.27
|
|
|
methotrexate 25 mg/mL 2 ML PF SDV [VDMC]
|
Facility
|
OP
|
$58.08
|
|
|
Service Code
|
HCPCS J9250
|
| Hospital Charge Code |
12477553
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$52.27 |
| Rate for Payer: Aetna of IA Commercial |
$52.27
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$52.27
|
| Rate for Payer: Aetna of IA Medicare |
$33.11
|
| Rate for Payer: Amerigroup Medicaid |
$29.31
|
| Rate for Payer: Amerigroup Medicare |
$29.33
|
| Rate for Payer: Cash Price |
$46.46
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$43.56
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$29.04
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.03
|
| Rate for Payer: Medical Associates Commercial |
$43.56
|
| Rate for Payer: Medical Associates Managed Medicare |
$29.04
|
| Rate for Payer: Midlands Choice Commercial |
$40.66
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$29.48
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$29.46
|
| Rate for Payer: Oscar Health of IA Commercial |
$43.56
|
| Rate for Payer: Partners Health Alliance Commercial |
$43.56
|
| Rate for Payer: United Healthcare Commercial |
$52.27
|
| Rate for Payer: United Healthcare Managed Medicare |
$34.27
|
|
|
methotrexate 25 mg/mL MDV 10ML [VDMC]
|
Facility
|
IP
|
$55.08
|
|
|
Service Code
|
HCPCS J9250
|
| Hospital Charge Code |
22813063
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna of IA Commercial |
$49.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.57
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.31
|
| Rate for Payer: Medical Associates Commercial |
$41.31
|
| Rate for Payer: Midlands Choice Commercial |
$38.56
|
| Rate for Payer: United Healthcare Commercial |
$49.57
|
|
|
methotrexate 25 mg/mL MDV 10ML [VDMC]
|
Facility
|
OP
|
$55.08
|
|
|
Service Code
|
HCPCS J9250
|
| Hospital Charge Code |
22813063
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$27.53 |
| Max. Negotiated Rate |
$49.57 |
| Rate for Payer: Aetna of IA Commercial |
$49.57
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$49.57
|
| Rate for Payer: Aetna of IA Medicare |
$31.40
|
| Rate for Payer: Amerigroup Medicaid |
$27.80
|
| Rate for Payer: Amerigroup Medicare |
$27.82
|
| Rate for Payer: Cash Price |
$44.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$41.31
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$27.54
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.53
|
| Rate for Payer: Medical Associates Commercial |
$41.31
|
| Rate for Payer: Medical Associates Managed Medicare |
$27.54
|
| Rate for Payer: Midlands Choice Commercial |
$38.56
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$27.95
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$27.94
|
| Rate for Payer: Oscar Health of IA Commercial |
$41.31
|
| Rate for Payer: Partners Health Alliance Commercial |
$41.31
|
| Rate for Payer: United Healthcare Commercial |
$49.57
|
| Rate for Payer: United Healthcare Managed Medicare |
$32.50
|
|
|
methotrexate 2.5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404216
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna of IA Commercial |
$2.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.88
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.40
|
| Rate for Payer: Medical Associates Commercial |
$2.40
|
| Rate for Payer: Midlands Choice Commercial |
$2.24
|
| Rate for Payer: United Healthcare Commercial |
$2.88
|
|
|
methotrexate 2.5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.20
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404216
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna of IA Commercial |
$2.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.88
|
| Rate for Payer: Aetna of IA Medicare |
$1.82
|
| Rate for Payer: Amerigroup Medicaid |
$1.62
|
| Rate for Payer: Amerigroup Medicare |
$1.62
|
| Rate for Payer: Cash Price |
$2.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.40
|
| 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 |
$2.40
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.60
|
| Rate for Payer: Midlands Choice Commercial |
$2.24
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.62
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.62
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.40
|
| Rate for Payer: United Healthcare Commercial |
$2.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.89
|
|
|
methylene blue 5 mg/mL 10ml SDV inj [VDMC]
|
Facility
|
IP
|
$789.71
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
18569211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$552.80 |
| Max. Negotiated Rate |
$710.74 |
| Rate for Payer: Aetna of IA Commercial |
$710.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$710.74
|
| Rate for Payer: Cash Price |
$631.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$592.28
|
| Rate for Payer: Medical Associates Commercial |
$592.28
|
| Rate for Payer: Midlands Choice Commercial |
$552.80
|
| Rate for Payer: United Healthcare Commercial |
$710.74
|
|
|
methylene blue 5 mg/mL 10ml SDV inj [VDMC]
|
Facility
|
OP
|
$789.71
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
18569211
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$394.70 |
| Max. Negotiated Rate |
$710.74 |
| Rate for Payer: Aetna of IA Commercial |
$710.74
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$710.74
|
| Rate for Payer: Aetna of IA Medicare |
$450.13
|
| Rate for Payer: Amerigroup Medicaid |
$398.57
|
| Rate for Payer: Amerigroup Medicare |
$398.80
|
| Rate for Payer: Cash Price |
$631.77
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$592.28
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$394.86
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$394.70
|
| Rate for Payer: Medical Associates Commercial |
$592.28
|
| Rate for Payer: Medical Associates Managed Medicare |
$394.86
|
| Rate for Payer: Midlands Choice Commercial |
$552.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$400.78
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$400.54
|
| Rate for Payer: Oscar Health of IA Commercial |
$592.28
|
| Rate for Payer: Partners Health Alliance Commercial |
$592.28
|
| Rate for Payer: United Healthcare Commercial |
$710.74
|
| Rate for Payer: United Healthcare Managed Medicare |
$465.93
|
|
|
methylergonovine 0.2 mg/mL Inj Sol [VDMC]
|
Facility
|
IP
|
$81.43
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10404634
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$73.29 |
| Rate for Payer: Aetna of IA Commercial |
$73.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.29
|
| Rate for Payer: Cash Price |
$65.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.07
|
| Rate for Payer: Medical Associates Commercial |
$61.07
|
| Rate for Payer: Midlands Choice Commercial |
$57.00
|
| Rate for Payer: United Healthcare Commercial |
$73.29
|
|
|
methylergonovine 0.2 mg/mL Inj Sol [VDMC]
|
Facility
|
OP
|
$81.43
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10404634
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$73.29 |
| Rate for Payer: Aetna of IA Commercial |
$73.29
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.29
|
| Rate for Payer: Aetna of IA Medicare |
$46.42
|
| Rate for Payer: Amerigroup Medicaid |
$41.10
|
| Rate for Payer: Amerigroup Medicare |
$41.12
|
| Rate for Payer: Cash Price |
$65.15
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.07
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$40.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$40.70
|
| Rate for Payer: Medical Associates Commercial |
$61.07
|
| Rate for Payer: Medical Associates Managed Medicare |
$40.72
|
| Rate for Payer: Midlands Choice Commercial |
$57.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$41.33
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$41.30
|
| Rate for Payer: Oscar Health of IA Commercial |
$61.07
|
| Rate for Payer: Partners Health Alliance Commercial |
$61.07
|
| Rate for Payer: United Healthcare Commercial |
$73.29
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.04
|
|
|
Methylmalonic Acid DMCL
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
8037742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$109.90 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
|
|
Methylmalonic Acid DMCL
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 83921
|
| Hospital Charge Code |
8037742
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$141.30 |
| Rate for Payer: Aetna of IA Commercial |
$141.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$141.30
|
| Rate for Payer: Aetna of IA Medicare |
$89.49
|
| Rate for Payer: Amerigroup Medicaid |
$79.24
|
| Rate for Payer: Amerigroup Medicare |
$79.28
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Cash Price |
$125.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$117.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$78.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$78.47
|
| Rate for Payer: Medical Associates Commercial |
$117.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$78.50
|
| Rate for Payer: Midlands Choice Commercial |
$109.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$79.68
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$79.63
|
| Rate for Payer: Oscar Health of IA Commercial |
$117.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$117.75
|
| Rate for Payer: United Healthcare Commercial |
$141.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$92.63
|
| Rate for Payer: Wellmark IA HMO |
$45.88
|
| Rate for Payer: Wellmark IA PPO |
$50.47
|
|
|
methylnaltrexone 12 mg/0.6 mL Inj Sol SDV [VDMC]
|
Facility
|
IP
|
$586.04
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
11224341
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$410.23 |
| Max. Negotiated Rate |
$527.44 |
| Rate for Payer: Aetna of IA Commercial |
$527.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$527.44
|
| Rate for Payer: Cash Price |
$468.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$439.53
|
| Rate for Payer: Medical Associates Commercial |
$439.53
|
| Rate for Payer: Midlands Choice Commercial |
$410.23
|
| Rate for Payer: United Healthcare Commercial |
$527.44
|
|
|
methylnaltrexone 12 mg/0.6 mL Inj Sol SDV [VDMC]
|
Facility
|
OP
|
$586.04
|
|
|
Service Code
|
HCPCS J2212
|
| Hospital Charge Code |
11224341
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$292.90 |
| Max. Negotiated Rate |
$527.44 |
| Rate for Payer: Aetna of IA Commercial |
$527.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$527.44
|
| Rate for Payer: Aetna of IA Medicare |
$334.04
|
| Rate for Payer: Amerigroup Medicaid |
$295.77
|
| Rate for Payer: Amerigroup Medicare |
$295.95
|
| Rate for Payer: Cash Price |
$468.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$439.53
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$293.02
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$292.90
|
| Rate for Payer: Medical Associates Commercial |
$439.53
|
| Rate for Payer: Medical Associates Managed Medicare |
$293.02
|
| Rate for Payer: Midlands Choice Commercial |
$410.23
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$297.42
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$297.24
|
| Rate for Payer: Oscar Health of IA Commercial |
$439.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$439.53
|
| Rate for Payer: United Healthcare Commercial |
$527.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$345.76
|
|
|
methylphenidate 5 mg Tab [VDMC]
|
Facility
|
IP
|
$3.15
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna of IA Commercial |
$2.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.84
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.36
|
| Rate for Payer: Medical Associates Commercial |
$2.36
|
| Rate for Payer: Midlands Choice Commercial |
$2.20
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
|
|
methylphenidate 5 mg Tab [VDMC]
|
Facility
|
OP
|
$3.15
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10404703
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna of IA Commercial |
$2.84
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$2.84
|
| Rate for Payer: Aetna of IA Medicare |
$1.80
|
| Rate for Payer: Amerigroup Medicaid |
$1.59
|
| Rate for Payer: Amerigroup Medicare |
$1.59
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$2.36
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$1.58
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.57
|
| Rate for Payer: Medical Associates Commercial |
$2.36
|
| Rate for Payer: Medical Associates Managed Medicare |
$1.58
|
| Rate for Payer: Midlands Choice Commercial |
$2.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.60
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$1.60
|
| Rate for Payer: Oscar Health of IA Commercial |
$2.36
|
| Rate for Payer: Partners Health Alliance Commercial |
$2.36
|
| Rate for Payer: United Healthcare Commercial |
$2.84
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.86
|
|
|
methylPREDNISolone 125 mg preservative-free Pow [VDMC]
|
Facility
|
OP
|
$50.46
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10404839
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$45.41 |
| Rate for Payer: Aetna of IA Commercial |
$45.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.41
|
| Rate for Payer: Aetna of IA Medicare |
$28.76
|
| Rate for Payer: Amerigroup Medicaid |
$25.47
|
| Rate for Payer: Amerigroup Medicare |
$25.48
|
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.84
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.23
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$25.22
|
| Rate for Payer: Medical Associates Commercial |
$37.84
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.23
|
| Rate for Payer: Midlands Choice Commercial |
$35.32
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$25.61
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$25.59
|
| Rate for Payer: Oscar Health of IA Commercial |
$37.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$37.84
|
| Rate for Payer: United Healthcare Commercial |
$45.41
|
| Rate for Payer: United Healthcare Managed Medicare |
$29.77
|
|
|
methylPREDNISolone 125 mg preservative-free Pow [VDMC]
|
Facility
|
IP
|
$50.46
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10404839
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$35.32 |
| Max. Negotiated Rate |
$45.41 |
| Rate for Payer: Aetna of IA Commercial |
$45.41
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$45.41
|
| Rate for Payer: Cash Price |
$40.37
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$37.84
|
| Rate for Payer: Medical Associates Commercial |
$37.84
|
| Rate for Payer: Midlands Choice Commercial |
$35.32
|
| Rate for Payer: United Healthcare Commercial |
$45.41
|
|
|
methylPREDNISolone 1gm PF SDV Pow [VDMC]
|
Facility
|
OP
|
$228.28
|
|
|
Service Code
|
HCPCS J2930
|
| Hospital Charge Code |
10404772
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$114.09 |
| Max. Negotiated Rate |
$205.45 |
| Rate for Payer: Aetna of IA Commercial |
$205.45
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$205.45
|
| Rate for Payer: Aetna of IA Medicare |
$130.12
|
| Rate for Payer: Amerigroup Medicaid |
$115.21
|
| Rate for Payer: Amerigroup Medicare |
$115.28
|
| Rate for Payer: Cash Price |
$182.62
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$171.21
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$114.14
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$114.09
|
| Rate for Payer: Medical Associates Commercial |
$171.21
|
| Rate for Payer: Medical Associates Managed Medicare |
$114.14
|
| Rate for Payer: Midlands Choice Commercial |
$159.80
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$115.85
|
| Rate for Payer: Molina Healthcare Managed Medicare |
$115.78
|
| Rate for Payer: Oscar Health of IA Commercial |
$171.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$171.21
|
| Rate for Payer: United Healthcare Commercial |
$205.45
|
| Rate for Payer: United Healthcare Managed Medicare |
$134.69
|
|
